Strategies for Counseling First Responders

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First responders treat a patient lying on a stretcher.

First responders are often the first to the scene of a medical emergency or crisis. Though distress and pressure may call forth the valor and bravery first responders embody, being repeatedly exposed to such conditions can weigh heavily on the mind — especially knowing that not every life can or will be saved. This has led to important discussions regarding what counseling resources are available for first responders.

Indeed, the mental health needs of first responders are getting more attention in the media, as well as places like fire stations and police precincts. However, despite recent gains in awareness, these needs are difficult to judge, much less address. First responders face a number of unique stressors that can leave them profoundly affected. The cultures of law enforcement, firefighters, paramedics, and other emergency services often make it hard for first responders to bring up issues they experience.

When they look for help, limited options for assistance and the stigma of seeking such services can be challenges. To repair the way that the mental health needs of first responders are addressed, outreach and awareness are needed. Counseling for first responders is crucial because it offers help to those who help our communities day in and day out. Counselors looking to work effectively with first responders should pursue the right education and training to help these individuals given the critical nature of their work.

First Responder Mental Health Statistics

First responder mental health statistics for firefighters, police officers and EMTs are by no means conclusive. However, definitive trends have emerged from studies that show that post-traumatic stress disorder (PTSD), suicide, depression, and alcohol and drug abuse are more prevalent in first responders than in civilians who aren’t regularly in high-intensity situations.

PTSD is a psychiatric disorder that occurs in those who’ve been a part of or witnessed a traumatic event, from witnessing a death to surviving a natural disaster. PTSD causes intense or disturbing thoughts and can greatly inhibit quality of life if left untreated. The disorder affects approximately 3.5% of Americans; however, first responders are five times more likely to be affected simply due to their line of work. A recent study has concluded that 30% of first responders have experienced PTSD, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Another study has concluded that 69% of first responders have reported not having enough recovery time between traumatic events. Further research has suggested that of those first responders who have PTSD, 20% have a substance abuse disorder.

Suicide is also particularly relevant in first responder mental health statistics. According to the Centers for Disease Control and Prevention (CDC), more than 47,500 people died from suicide in 2019. Also according to the CDC, 12 million people had ideations of suicide and 1.4 million attempted it. Suicide is the 10th leading cause of death in the U.S.

Once again, these statistics may impact firefighters, EMTs and other first responders at a greater proportion than the general population. Recent study results reported by the CDC have suggested that police officers and firefighters are more likely to die from suicide than in the line of duty. A recent study has concluded that 37% of firefighters and EMTs have seriously contemplated suicide. The CDC has reported that “even given the high number of suicides, these deaths among first responders are likely underreported. There are insufficient data on suicides and mental health issues among these workers.”

Far more work needs to be done to conduct studies, gather reliable data and provide counseling for first responders. One problem is the stigma associated with reaching out for professional help. A recent study has concluded that 57% of first responders have feared negative repercussions for seeking help, while 47% have reported a fear of being demoted or fired, according to Kaiser Permanente. The data suggests many first responders “tough it out” rather than seek the help they need.

However, there’s some encouraging data. More than 70% of first responders have said they’d be more likely to seek professional counseling if a leader in their organization spoke openly about their experience, and 80% said if a close colleague spoke up, they’d be more likely to seek help for themselves.

Given how severe and persistent mental health issues are in first responders, counselors often see clients in such professions. However, treating first responders can be an imposing task. It takes a genuine understanding of the internal and external pressures to help clients express themselves in honest ways and pursue healthy habits, even in the face of the life-or-death situations they may face daily.

First Responder Mental Health Resources

Despite a clear need for first responder mental health resources and counseling for first responders, not all of them have access to services such as an employee assistance program (EAP) and counseling. To make things worse, using the resources that exist remains an ever-increasing concern. Removing the stigma surrounding first responder mental health resources will be a major leap forward in progress.

For first responders concerned that seeking help may hurt them professionally, several organizations specialize in trauma-informed counseling without involving those to whom they report. For instance, the All Clear Foundation has several online and phone resources for those in need of counseling, crisis intervention or personal wellness assistance. The foundation even has stress management resources devoted specifically for first responders’ families.

The Code Green Campaign is another organization that provides mental health resources for first responders who are dealing with trauma, PTSD or thoughts of suicide. Safe Call Now is a 24-hour hotline that connects first responders with mental health professionals who can provide them with trauma-informed counseling. CopLine is a dedicated hotline for police officers in crisis or dealing with mental health issues. The Share the Load program, which the National Volunteer Fire Council runs, assists firefighters in finding treatment and crisis intervention. These and other mental health resources are dedicated to offering first responders help without notifying a department head or supervisor.

For counselors, raising awareness of available first responder mental health resources are critical to improving coverage of the client groups’ needs. However, institutional change also needs to occur, and that all starts with admitting a problem exists. A recent study has indicated that 85% of all first responders have experienced symptoms of a mental health condition, according to Kaiser Permanente. The majority of those individuals are pushing through and either ignoring the issue or self-medicating.

Counseling for first responders does work, and according to one study, the majority of those who participated in online mindfulness training experienced less stress, were more engaged at work and felt more resilient while on the job. Counselors should be highly attuned to the fact that their intervention matters and that it can result in first responders performing better on the job because their mental health issues are being addressed.

Trauma-Informed Counseling Strategies

Another aspect mental health counselors have to keep in mind when treating first responder clients is that empathy can only take them so far. First responders see stress and tragedies on a nearly unimaginable basis. Having these unique experiences often leaves first responders feeling as if no one else could possibly understand what they go through besides peers. Although trauma-informed counseling is specifically designed to address the circumstances first responders endure, some still avoid opening up to counselors or avoid seeking treatment entirely.

One pitfall counselors must avoid in treating first responder clients is being awed or mystified by the lengths first responders go to put their own lives on the line for others. Counselors might not be able to imagine encountering death on the job, let alone carrying through the rest of the day; but this is the first responder’s reality. Individuals in such careers need objective help in learning more about mental health or resources they can take advantage of. A trend among first responders (as well as supportive management) is the desire for counselors who can offer useful help for what first responders go through.

At its core, trauma-informed counseling relies on counselors being able to connect to job-specific stress that police officers, firefighters and EMTs encounter. Though not every mental health counselor who treats first responder clients will have that kind of experience, coming into a relationship aware of the unique stresses and emotions of first responders can help counselors provide effective help.

Consider Bradley University for a Master of Arts in Counseling

As a number of studies and surveys show, first responders bear the brunt of their mental health issues, unable to turn to outlets of professional help because of stigma. Fortunately, that stigma is decreasing, and counseling for first responders is becoming more widely accepted and even encouraged. Mental health counselors who may treat first responder clients need to come prepared with a deep knowledge of counseling strategies and education to help tackle the unique mental health needs of police, firefighters, EMTs, and others. If you’re interested in pursuing a postgraduate degree to further improve your skills as a counselor, contact Bradley University for more information on the school’s online Master of Arts in Counseling program.

Recommended Readings

Substance Abuse Counselor Salary and Potential Careers

The Role of a Corporate Trainer in Educating the Workforce

How Do You Get Into Rehabilitation Counseling?


All Clear Foundation, Responder Resources

American Psychiatric Association, What Is Posttraumatic Stress Disorder?

Centers for Disease Control and Prevention, Fast Facts

Centers for Disease Control and Prevention, Suicides Among First Responders: A Call to Action

Counseling Today, “Putting First Responders’ Mental Health on the Front Lines”, “The Link Between PTSD and Addiction”

GenPsych, Mental Health Issues for First Responders: The Risk Factors

Kaiser Permanente, “How Employers Can Help First Responders Stay Mentally and Emotionally Strong”

Mission Harbor Behavioral Health, First Responders: A Guide to Their Unique Mental Health and Addiction Needs

Substance Abuse and Mental Health Services Administration, First Responders: Behavioral Health

Concerns, Emergency Response, and Trauma

The Code Green Campaign, Help & Resources