Confessions of a mental health clinician: What I didn't know

I am deeply embarrassed, and here's why. I dedicated a decade to a doctoral program in clinical psychology at a university that specialized in cultural competency. Yet, despite this training, I only realized that first responders constitute a distinct culture, after spending two years embedded in the first responder communities.

To make matters worse, it took me two months in this environment to recognize the impact of the traumatic experiences these professionals encounter, after listening to several firefighters candidly share their struggles. I recognize that admitting this might discredit me. However, it highlights the significance of the gap in psychological services for first responders.

Historically, cultures were defined by race and ethnicity rather than specific careers, leading to first responders being grouped with the general population (Merriam-Webster) . This contributed to the na?ve confessions I shared, as without immersing myself in these industries, I might have remained oblivious to their cultural intolerance of expressing emotional reactions to the calls and the stigma that follows them like a shadow, threatening their credibility, confidence, and career.

It wasn’t until the late 1980s, when researchers like Geert Hofstede introduced cultural analysis to the workplace (Verywell Mind ). It took another decade before the unique stressors faced by emergency services caught the attention of academics and professionals, leading to the full acknowledgment of first responder culture. (ICISF )

Awareness of the mental health needs of first responders began to gain traction in the 2000s, driven by research reporting the high prevalence of PTSD, depression, and anxiety among first responders. (Psychiatric Times ) (First Responders Foundation ). A 2018 white paper by the Ruderman Family Foundation reported that first responders are more likely to die by suicide than from job-related injuries. (U.S. Fire Administration ) (Ruderman Family Foundation ).

Let me say that again: our lifesavers, who override a human's instinct for survival and find purpose in running into fires and toward bullets, are dying at higher rates by their own hand than by their dangerous careers. The culture within first responders harbors a complex stance towards the stigma surrounding mental health. It casts a shadow, allowing some to cling to outdated "macho" ideals by denying their emotional vulnerabilities, while simultaneously instilling a fear that undermines trust and professional credibility.

This internal conflict is illustrated in the 2018 NBC/IAFF survey of 7,000 firefighters, revealing deep-seated concerns: over 80% identified stigma as a significant barrier to seeking mental health support, 83% feared appearing weak, 60% doubted their colleagues' trust in their judgment under pressure, and 46% were anxious about potentially losing their job job I-Team: National Data Shows Firefighters’ Mental, Emotional Health Not Getting Enough Attention – NBC New York .

Moreover, the survey underscores a critical contradiction: while stigma is often associated with attributes perceived as rare or deviant, the responses paint a different picture. A staggering 95% admitted to experiencing critical stress, 75% believed stressful experiences caused lingering or unresolved issues, and 65% were haunted by traumatic memories. These figures demonstrate that mental health challenges are far from uncommon in the firefighting community, highlighting an urgent need for how mental health is perceived and handled within this essential profession.

For some of you, the honest responses to this anonymous survey may be surprising but given the cultural distrust of true anonymity in surveys, it's reasonable to suspect that the actual figures might be higher than reported. Studies on first responders have also demonstrated significant brain structural changes that contribute to mental health issues. This next paragraph is pivotal, perhaps the most significant a first responder will encounter concerning mental health.

The question for first responders shouldn't be if they will face mental health challenges, but when. Chronic exposure to trauma among firefighters has been linked to overactivity in the limbic system, the part of the brain associated with emotions. This heightened activity can lead to depression, anger, and social isolation Mental Healthcare Clinic Focusing On Your Brain Health | Dr. Amen Amen Clinics.

SPECT scans , a type of brain imaging technique, reveal that firefighters suffering from depression and trauma-related symptoms often exhibit reduced blood flow in specific brain regions, worsening their mental health issues. These findings confirm that psychiatric conditions have a biological basis, influenced by both vicarious traumatic experiences and exposure to harmful substances encountered during firefighting.

Given the clear evidence of neurological changes resulting from chronic exposure to trauma among first responders, as indicated by research from Amen Clinics, it becomes imperative to not only address these issues reactively but also proactively through education and treatment.

Educational programs and training for first responders need to incorporate this knowledge, emphasizing the neurobiological effects of their work environments, and integrating counterbalancing techniques into their protocols. This will prepare first responders for the mental health challenges they will encounter, offering them strategies to manage stress and trauma effectively.

Additionally, mental health interventions need to be designed with an understanding of these specific neurobiological changes, ensuring that treatment options are both relevant and effective for mitigating the impact of vicarious trauma. This approach aims not only to alleviate current mental health struggles but also to equip responders with preventive strategies against neurological changes. By doing so, we foster a more resilient generation of first responders, prepared to handle the psychological demands of their critical roles.

Currently, eight states--California, Illinois, Massachusetts, Michigan, Minnesota, Oregon, Vermont, and Virginia--have specific legislation providing benefits for first responders with PTSD, showing an evolving understanding of the psychological risks and a significant shift in recognizing mental health issues as legitimate job-related injuries, like a twisted ankle Workers’ Compensation for PTSD: Which States Offer Benefits? This shift legitimizes mental health injuries as a common risk of the job and requires formal support mechanisms.

In conclusion, this article underscores the need for a specialized approach to mental health within the first responder community. It challenges the pervasive stigma surrounding mental health issues in this sector, emphasizing that such conditions are common outcomes, not rare deviations, due to the neurobiological changes from routine exposure to vicarious trauma. The fact that workers' compensation now covers PTSD in several states highlights the recognition of mental health issues as legitimate, non-dismissible occupational hazards. This recognition reinforces that these are significant aspects of professional life that require attention and care.

About the Author

Marie G. Gumá, born in Caracas, Venezuela, moved to Miami, Florida, at the age of three. She pursued a career in psychology, earning a Bachelor's degree and a Master of Science in Clinical Psychology from Carlos Albizu University, graduating Cum Laude and joining the PSI CHI Honor Society, and competed doctoral program’s coursework in clinical psychology from the same institution. Marie is currently working towards a Doctorate in Higher Education and Leadership from Gwynedd Mercy University, with expected completion in March 2025.

Marie has extensive experience in mental health, particularly within the first responder community, having founded Command Counseling Center, a company that manages mental health programs for first responder departments. She has received numerous awards for her contributions, including Advocate of the Year in 2018, and has been a key figure in responding to critical incidents such as the Marjory Stoneman Douglas High School shooting and the Surfside Building Collapse.