Safeguarding firefighter and EMS mental health

May 14, 2024

Kristen Wheldon, President and Founder of the Fire Service Psychology Association explains the importance of comprehensive mental health support in fire services

Over the past ten years, the fire service community has taken significant steps towards addressing the mental health needs of their firefighters and EMS providers.

Notably, the National Fallen Firefighters Foundation has recognized the importance of providing psychological support to firefighters throughout their careers.

The IAFC has dedicated resources to a Safety and Survival Section, while the IAFF has partnered with Advanced Recovery Systems to establish their Center for Excellence.

Various other initiatives have been implemented to identify and tackle mental health challenges.

At the local level, many organizations have developed peer support teams and collaborated with mental health professionals to offer clinical assistance to their personnel.

Some departments have even hired licensed psychologists to manage behavioral health programs.

Enhancing peer support and addressing clinician shortages

Acknowledging that firefighters often rely on their peers for initial support, efforts have been made to enhance their capacity to address the mental well-being of their fellow firefighters.

However, there remains a shortage of mental health clinicians, particularly those familiar with the unique cultures of the fire service and EMS.

This shortage impacts firefighters’ willingness to seek mental health services as they may find it difficult to find a provider to connect with.

To bridge this gap, emerging organizations have developed protocols for offering immediate clinical support after incidents, utilizing EMDR protocols as a solution.

Despite perceived benefits, there are concerns that this approach may have adverse effects.

Best practices for peer support teams

Typically, firefighters are not trained as mental health professionals.

(There are a few exceptions where firefighters and EMS providers go on to become clinicians.) Unlike mental health providers, who undergo degree programs, national and state licensing examinations, and supervised experiences before obtaining licensure to offer services, peer support certification is different.

A certification and a license are different in the eyes of the law.

Peer support teams are not designed to deliver mental health treatment but rather to offer support.

Originating from military contexts, these programs were created to identify risks and make appropriate referrals.

They prove effective by allowing peers to discuss information with someone who listens attentively and empathizes due to shared experiences.

When experiences are normalized, it provides a chance to process information.

Encouraging natural recovery post-trauma

As it relates to post traumatic stress, safeguarding firefighter and EMS mental health starts with these steps.

  1. We need to encourage natural recovery in the first thirty days after trauma exposure as research suggests eight out of ten people exposed do not require clinical support.
  2. We need to use a Trauma Risk Management system to identify individuals who may not recover naturally and who may need additional support.
  3. We should not pathologize people who are on their way to natural recovery. That can cause harm.
  4. We do not want peer support teams to engage in mental health treatment without a license. This creates legal liabilities for those offering support.
  5. In the event a peer support team member provides unlicensed therapy, we do not want that individual to suffer an emotional burden if things go wrong.
  6. We should not psychologically tax a peer support team by encouraging them to take on the responsibility of providing therapy to their peers in addition to all the other responsibilities they already have as firefighters and EMS providers.
  7. We want to encourage mental health professionals to engage with the fire service psychology community and we do that by embracing not replacing professional mental health services.

As mental health professionals endeavor to integrate into the fire service, it’s paramount to uphold the principle of doing no harm.

This echoes the Hippocratic Oath’s foundational tenet, “Primum non nocere,” which emphasizes prioritizing the safety and well-being of those we serve.

Aligned with this oath, we must adhere to ethical guidelines established by organizations like the American Psychological Association (APA), emphasizing beneficence, non-maleficence, autonomy, and justice.

Addressing systemic barriers to mental health access

These principles underpin psychologists’ practice, with the integration of peer support teams reinforcing our commitment to preventing harm.

While acknowledging the shortage of clinicians serving the fire service and the persistent stigma hindering firefighters’ access to mental health resources, it’s crucial to address these systemic barriers directly rather than offering temporary solutions that may exacerbate issues in the long run.

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