For first responders — firefighters, paramedics and police officers — job stress goes far beyond an unpredictable boss, stringent deadlines or unpleasant co-workers.
First responders' workplaces are on the front lines of accidents, violence, fires, injury, threats to personal safety and death. They face potentially traumatic situations head-on every day. Unrelenting stress can result in post-traumatic stress disorder, depression, anxiety, addiction and suicide at rates much higher than those experienced by people in other professions.
Research on first responders' mental health issues is scarce. A 2014 article in first responder-focused EMS World magazine described an elevated risk of stress and suicide among first responders, citing surveys and anecdotal reports. The same year, a group of emergency medical services professionals founded the Code Green Campaign, a nonprofit organization aimed at raising awareness of the high rates of mental health problems, substance abuse and suicide among first responders.
"We need comprehensive studies of large, diverse first responder groups in urban and rural areas," said Ann Marie Farina, Code Green founder and board president.
Lack of awareness of PTSD among first responders is compounded by their reluctance to seek counseling. First responders perceive themselves as physically and emotionally resilient and may deny that they have been traumatized. Rather than ask for help, some turn to unhealthy ways of coping.
First responders tend to live very healthy lifestyles, but they may self-medicate PTSD symptoms with alcohol, said Ernest Bordini, psychologist and executive director of Clinical Psychology Associates, a psychological care facility in Gainesville, Fla. Bordini regularly evaluates and provides counseling for first responders.
"The first responder culture supports the idea that you work hard, take risks, remain stoic and drink heavily, but doesn't necessarily support the idea of being weak or vulnerable," he said. "Drinking doesn't alienate you from your peers."
Bordini said that first responders may hide PTSD symptoms or addiction struggles, fearing damage to their careers. When they seek mental health treatment, they need a therapist who is familiar with their job. "Having a therapist who can relate to [first responders'] life experiences of danger and who understands their profession is critical," he said.
Therapy that mirrors the intensely physical aspect of first responders' work is effective in helping with addiction and trauma issues, said Luke Meier, therapist at Morningside Recovery in Irvine. Morningside offers a special program that combines 30- to 90-day out-patient treatment with sessions of rigorous physical activity. The structure and discipline of the program suits the special needs of first responders, he said.
Participants play monthly paintball games that both re-create and relieve stress, Meier said. "Paintball places a person in a stressful situation. At the same time, it provides a physical release." More than a game, paintball models the hypervigilance, danger and duress first responders face, he said. "As they run around in the game, they're thinking, 'Where is my teammate? I don't want to get shot. Can I trust these guys?'"
After the paintball sessions, Meier talks with the group and with individual participants about what happened in the game, focusing on how it mirrors their work. The paintball experience often helps first responders identify feelings of anxiety or memories they may be repressing, Meier said. "We process through the emotional aspects of the game. It's a very effective way to build trust, practice reacting calmly to stress and increase communication," he said.
"The goal is to help first responders work through trauma and practice the coping skills they learn on the paintball field in real life," Meier said. While Morningside has not yet measured the results of the program for first responders with pre- and post-testing of PTSD symptoms or addictive behaviors, testimony from participants suggests the therapy is beneficial.
"The accolades come from people who complete our program and recommend someone else to take their place on their paintball team," Meier said.
—Treacy Colbert for Morningside Recovery