Structural Barriers
First responders have all reported limited access to treatment (Haugen et al., 2017; Jones et al., 2020; Lentz et al., 2021; O'Dare et al., 2024). First responders work a variety of schedules. Firefighters and EMS personnel can work a twenty-four-hour shift with two to four days off in between, and the shifts are usually expressed in hours as "time at work/time off work" (24/48, 24/72, or 48/96). The New York City Fire Department (FDNY) has two shifts daily, nine hours in the morning and fifteen hours in the evening, rotating from days to nights. FDNY shifts also have a forty-eight-hour time off and a seventy-two-hour time off period in their rotation. LEOs and PTCOs often work twelve-hour shifts rotating between nights and days every week or biweekly. The variety of schedules and hours of work make finding appointments with clinicians difficult at best.
Law enforcement officers face additional barriers that are unique to their profession. If the LEO discloses that they are seeking mental health services or are having issues with their mental health, they could trigger a red flag process. This process, which may require the confiscation of the LEO's firearms, can have a significant impact on their ability to perform their job, either temporarily or permanently, raising serious concerns about their well-being (O'Dare et al., 2024). This potential consequence might be one reason LEOs are less likely to disclose mental illness to a co-worker or a supervisor than firefighters (Bowers et al., 2022).
Firefighters, emergency medical personnel, LEOs, and Public Telecommunication Officers (PTCOs) have all mentioned cost being a barrier to seeking care (Bowers et al., 2022; Jones et al., 2020; O'Dare et al., 2024). Many public service departments have Employee Assistance Programs (EAP), accessible to employees and typically provide up to six sessions with a therapist. EAPs are employer-sponsored programs designed to assist employees in resolving personal problems that may adversely affect their work performance, health, and well-being. The data reviewed did not differentiate whether access to EAP programs was an issue of cost or whether continuing therapy once the EAP-covered sessions met the limit was the cost.
Volunteer first responders struggle to find the time for mental health. Volunteer firefighters comprise 69% of the firefighter population in the United States (Stanley et al., 2017). The struggle between working a full-time job, family commitments, and community commitments through the volunteer fire department inhibits finding time to attend psychotherapy. Volunteers often serve in rural areas and communities of less than twenty-five thousand people (Stanley et al., 2017). Rural communities are also bereft of mental health services. Morales, Barksdale, and Beckel-Mitchner (2020) say over 60% of rural communities live in areas with a shortage of mental health providers.
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
Haugen, P. T., McCrillis, A. M., Smid, G. E., & Nijdam, M. J. (2017). Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. Journal of Psychiatric Research, 94, 218–229. http://dx.doi.org/10.1016/j.jpsychires.2017.08.001
Jones, S., Agud, K., & McSweeney, J. (2020). Barriers and Facilitators to Seeking Mental Health Care Among First Responders: “Removing the Darkness.” Journal of the American Psychiatric Nurses Association, 26(1), 43–54. https://doi.org/10.1177/1078390319871997
Lentz, L. M., Smith-MacDonald, L., Malloy, D., Carleton, R. N., & Brémault-Phillips, S. (2021). Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers. Frontiers in Psychology, 12, 639781. https://doi.org/10.3389/fpsyg.2021.639781
O’Dare, K., Atwell, L., King, E., Dillard, D., Herzog, J., & Rotunda, R. (2024). Subjective experiences, perceptions, and meanings associated with barriers to mental seeking health care among first responders. Advances in Mental Health, 0(0), 1–20. https://doi.org/10.1080/18387357.2024.2320635
Stanley, I. H., Boffa, J. W., Hom, M. A., Kimbrel, N. A., & Joiner, T. E. (2017). Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters. Psychiatry Research, 247, 236–242. https://doi.org/10.1016/j.psychres.2016.11.037
