Barriers to Care for First Responders

As evidence supporting mental health issues in first responders continues to mount, it's crucial that we, as a society, understand and empathize with their unique challenges. Some data is extrapolated from studies with the military, but a consensus is forming that first responders are at a higher risk for mental health problems than the public. A survey of Canadian firefighters found 44.5% of respondents screened positive for one or more mental health disorders (Smith et al., 2021). Public safety telecommunication officers (PSTCOs), 911 call takers and dispatchers, experience moderate to severe depression at a rate ten times higher than the national average (O’Dare et al., 2023). Emergency medical system workers (EMS), which include paramedics and EMTs, are estimated to experience PTSD symptoms in 15% of cases, compared to 1.3 to 2.9% in the general population (Petrie et al., 2018). Wagner et al. (2020) estimated the average prevalence of PTSD in law enforcement officers (LEOs) is 14.87% (Wagner et al., 2020).  First responders face unique mental health issues from their job, but they also face particular barriers to seeking care from their job and culture.

Barriers to care have been broken into four sections: cultural barriers, structural barriers, organizational barriers, and personal barriers. Cultural barriers exist when there is a spoken or unspoken perceptual set of beliefs or rules governing the population’s behavior. Structural barriers include availability, cost, and access to treatment. Organizational barriers are those which the place of employment, or organization the individual gives volunteer time to, intentionally or unintentionally put roadblocks between the first responder and mental health treatment. Personal barriers, for the purpose of this paper, are the internal factors that prevent a person from seeking mental health treatment. These can include fear of stigma, concerns about confidentiality, or a belief that seeking help is a sign of weakness. Personal barriers are often perceived issues from personal experience or tales heard from other first responders.

References

ODare, K., Dillard, D., King, E., Dilks Jr, J., Herzog, J., Rotunda, R., Close, F., & Hartman, M. (2024). The 2nd Alarm Project: Bridging Social Work and Public Health to Improve Mental Wellness in the Fire Service. Social Work in Public Health, 39(1), 93–104. https://doi.org/10.1080/19371918.2024.2318382

Petrie, K., Milligan-Saville, J., Aim&eacute, Gayed, E., Deady, M., Phelps, A., Dell, L., & Forbes, D. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53(9), 897–910. https://doi.org/10.1007/s00127-018-1539-5

Smith, E., Dean, G., & Holmes, L. (2021). Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review. Prehospital and Disaster Medicine, 36(4), 475–480. https://doi.org/10.1017/S1049023X21000431

Wagner, S. L., White, N., Fyfe, T., Matthews, L. R., Randall, C., Regehr, C., White, M., Alden, L. E., Buys, N., Carey, M. G., Corneil, W., Fraess-Phillips, A., Krutop, E., & Fleischmann, M. H. (2020). Systematic review of posttraumatic stress disorder in police officers following routine work-related critical incident exposure. American Journal of Industrial Medicine, 63(7), 600–615. https://doi.org/10.1002/ajim.23120