Cultural Barriers

The two kinds of cultural barriers noted are the first responders' internal culture and the external societal culture. Among the studies reviewed, I found the primary barrier to seeking mental health services related to the stigma of being seen or known to have participated in mental health treatment (Gulliver et al. 2019; O’Dare et al. 2024).

In the paper, "Obstacles to mental health treatment: Similarities and differences among first responder groups," Bowers et al. (2022) identify three types of mental health stigma: public stigma, personal stigma, and label avoidance.

Public stigma is the individual's awareness of how the public perceives mental illness. It is part of the social-cultural barrier. In the public's mind, first responders are protectors of the community and symbols of heroism (Partnoff, 2021). When the public calls for emergency services, they expect professionals to arrive and solve the problem quickly and efficiently. This societal expectation, regardless of the last incident, the first responder was on, can be overwhelming. The public's desire for a quick resolution can add to the pressure on first responders.

Personal stigma consists of how the individual perceives mental illness in themselves. The internal culture of first responders heavily influences personal stigma. Firefighting culture is a masculine hegemony (Partnoff, 2021; Thurnell-Read & Parker, 2008). Within this culture, the masculine status is precarious. It can be revoked by the members of the culture when a person does not live up to the ideals of the culture (Partnoff, 2021). Acceptance in the firehouse is to become part of the family. Firefighters refer to each other as brothers and sisters. Having the masculine status removed makes the former family member an outsider. The pressure of maintaining status in the culture influences how the individual perceives mental health treatment. Leadership, whether the senior firefighter or the battalion chief, discourages mental health therapy and views those who want help as weak (ODare et al., 2024). Cultural suppression of mental health wellness affects how the individual perceives mental health problems within themselves, thus growing the personal stigma of seeking help.  Personal stigma decreases self-worth, which leads to label avoidance. This erosion of self-worth is a concerning consequence of the cultural barriers to mental health treatment.

Label avoidance is denying the symptoms or hiding symptoms to avoid the negative feelings corresponding with public stigma and personal stigma.  Masculine hegemonic culture contributes to label avoidance with the belief that any person who needs mental health treatment is weak. First responders will avoid talking about symptoms with co-workers and family to avoid being labeled as weak or unstable. This avoidance is not a sign of weakness, but a testament to the strength and resilience of first responders. Mutual trust is the glue that holds first responders together while working in emergency situations. Losing the trust of a firefighter means that a person might be unable to save her brothers when they need it most.  Firefighters will go to many lengths to avoid being labeled with a mental health disorder.

References

Bowers, C. A., Beidel, D. C., & Marks, M. R. (2022). Obstacles to mental health treatment: Similarities and differences among first responder groups. Journal of Community Safety and Well-Being, 7(2), Article 2. https://doi.org/10.35502/jcswb.248

Gulliver, S. B., Pennington, M. L., Torres, V. A., Steffen, L. E., Mardikar, A., Leto, F., Ostiguy, W., Zimering, R. T., & Kimbrel, N. A. (2019). Behavioral health programs in fire service: Surveying access and preferences. Psychological Services, 16(2), 340–345. https://doi.org/10.1037/ser0000222

Partnoff, N. L. (2021). “Who’s Going to Flinch?”: Masculinity in the Fire Service and Barriers to Mental Health Help-Seeking [M.S.W., California State University, Fresno]. https://www.proquest.com/docview/2518686037/abstract/C5A714325A094E54PQ/1

Thurnell-Read, T., & Parker, A. (2008). Men, masculinities and firefighting: Occupational identity, shop-floor culture and organisational change. Emotion, Space and Society, 1(2), 127–134. https://doi.org/10.1016/j.emospa.2009.03.001