Peer Support and First Responders: The Time For Change is Now
David Speciale
Paramedic, Chaplain, State Ambassador and Peer Support Specialist for the state of Minnesota with Mind The Frontline. First Responder Mental Health Crisis and Trauma Specialist. Current PhD student in Clinical Psychology
To the reader of this article:
Publishing this blog/article is required for my current course in CPSY:8700 Psychology and Social Change with Walden University and is written by a PhD student of Clinical Psychology
Key Points
My journey as a paramedic has led me to finish a bachelor’s degree in psychology and a master’s in Crisis and Trauma Counseling. I am currently working on my PhD in Clinical Psychology at Walden University. The mental health struggles I have personally dealt with have led me to be an advocate of social change for first responders’ mental health. I am on the path to becoming a licensed psychologist to help first responders in a clinical mental health role.
As a paramedic, I have spent many years (14) in an ambulance, responding to 911 calls for help and transporting patients from one hospital to another. I have witnessed many traumatic incidents; I have been spit on, kicked, punched, assaulted, belittled, mocked, and made to feel unworthy of being and working as a paramedic. Mostly from people who are having a bad day, a mental health crisis, or have an altered mental status from various substances, but the belittling, mocking, and mistreatment by fellow first responders, partners, supervisors, and managers over the years have opened my eyes to the need for social change in how mental health is approached among first responders.
First responders need to move away from the toxic “suck it up” way of life to one that allows emotions to be felt, thoughts and feelings to be expressed healthily, and a sense of community that promotes camaraderie. After all, first responders are described as part of a brotherhood or sisterhood (Q&A, 2019), and a functional and healthy family does not belittle and put down one another. Sure, siblings fight sometimes, but when push comes to shove, a brother or sister will always have their sibling’s back. So, why then, do many first responders report the opposite of feeling like a sisterhood and brotherhood? The way to move past the toxic “suck it up” culture, the “show no emotion because it shows weakness” culture is through peer support and mental health resources being brought to first responders instead of first responders desperately searching for support and help.
Peer Support Among First Responders
As a first responder, I completely understand the hesitation in reaching out for help. Many first responders are exposed to crime scenes, violence, murders, deaths, shootings, stabbings, drug-related incidents, and all the dark and evil things in the world (Zegel et al., 2023). Seeing and dealing with these things causes trust in others to dwindle away, but trust in others does not completely disappear. First responders trust other first responders, and when a first responder is struggling with anything, whether it be mental health, physical health, financial problems, or whatever life issue one can think of, they turn to each other because first responders trust other first responders (Tjin et al., 2022).
A study conducted by Carelton et al. (2020) reveals many diverse stressors that first responders deal with daily. Some of these stressors include traumatic calls, workplace bullying, poor work-life balance, constant policy changes, unsupportive supervisors and managers, staff shortages leading to increased workloads, perceived pressure to volunteer free time, lack of resources, fatigue, long shifts, limitations to outside of work social life, and many more stressors were identified. The top stressors identified were the lack of support from coworkers and dealing with workplace bullying, which should be surprising to some people who are not first responders and believe that the traumatic scenes that first responders are exposed to are not the top stressors that first responders must deal with.
What is Peer Support?
Peer support is described as someone coming alongside another person, one who is liked and respected by the other, and sharing concerns while supporting each other and lifting one another up in positivity (Shalaby & Agyapong, 2020). Peer support can be seen in many examples. It can be a coworker helping another coworker who is having a bad day. It can look like one grocery shopper helping another person in the store find an item. It can even be seen in two people who have never met before but have similar jobs (first responders) giving a listening ear to the other to provide support after a rough call that they responded to.
One thing that peer support is not is conditional. This means that for one to receive peer support, one must meet certain criteria to be eligible to even meet and speak with the peer support team or a peer support person. Such as a coworker who reaches out for peer support through their employer’s peer support team struggling with personal life issues. This person is met with a response that conveys the message that if it is not related to your job performance and your employment here, then we cannot provide you with support. No. Peer support is supporting your peer, period. If my coworker is struggling with depression unrelated to the job, I support them. If a fellow student in my program struggles with something school-related or not, I offer them support. If I am out in public shopping, and another shopper is having difficulty finding something, I help them because, at that moment, we are both shoppers and, therefore, peers.
Unconditional positive regard, a concept from Psychologist Carl Rogers, is when a person can set their biases aside towards another person and provide support to them and regard them as worthy of needing assistance, love, kindness, and so on (Murphy et al., 2017). Why, then, is peer support, which is a person or team of people willing to give assistance, kindness, and show compassion to another, limited in when and how they are allowed to do so? This is how peer support is being approached through employer-led peer support teams and peer support personnel and not with unconditional positive regard. This is where change needs to take place, and this is sadly true based on personal experiences and evidence found through education and research that has already been conducted on first responder mental health and peer support. Next, I will discuss the evidence that supports the need for change and the need for peer support teams and peer support persons.
Peer support among first responders can make a difference in someone suffering from post-traumatic stress and acute stress or overcoming post-traumatic stress and acute stress and overcoming the traumatic stress of the job (Fallon et al., 2023). It is not a matter of “if” peer support is needed; it is a matter of “when” it is needed, and peer support is always needed. Peer support and social support are the leading contributing factors to how a person copes with and grows past a traumatic experience (Calhoun et al., 2022). Some people have the mental fortitude and resilience to overcome a traumatic experience on their own, but some do not and need the support of others to overcome difficult situations and times.
Having a peer support team in place that practices the concept of unconditional positive regard that was mentioned earlier and does not place limitations on who and why a person needs peer support is important. As a first responder, you support your peers without belittling them because you have seen worse in your career. If that is true, the other person who is struggling probably has not witnessed something worse and needs support for what they are currently dealing with. So, support them and show kindness to your peers, whether you are part of the peer support team or not.
Peer support is rooted in social support theory (Calhoun et al., 2022) and can be considered a branch of social support that targets a specific social group or person of a specific social group. Peer support is one of the leading factors of post-traumatic growth and healing after a traumatic incident, and without social support and peer support, the person that experienced the traumatic event is less likely than those who receive social support to overcome and grow from the traumatic event (Y. Wang et al., 2021).
The Role of Psychology Regarding Peer Support
Psychology plays a vital role in peer support in the sense that peer support and social support are based on the psychological well-being of others. Psychology provides the tools and understanding that make peer support an effective and transformative experience for those receiving peer support (Shalaby & Agyapong, 2020). Some of the psychological tools that peer support uses include empathy and understanding, community and connection, empowerment, and allows for coping with stress and trauma skill development through the sharing of lived experiences of others.
In regard to first responders, some peers with shared lived experiences may say that they have seen worse or dealt with worse things in their careers when speaking with a less experienced peer. This is not helpful and makes peer support ineffective. What makes peer support effective is the peer supporter realizing that what their peer is going through is something that they have dealt with before and providing the peer with examples, coping skills, and an uplifting spirit to help them overcome their current struggles. One example would be the more experienced peer offering the other a supportive environment that facilitates openness and sharing of lived experiences, which would allow the less experienced peer needing support to see and hear how others have overcome their struggles and identify ways that may work for them to overcome their struggles.
Ethnic Inequalities in Peer Support
Effective peer support seeks to eliminate ethnic inequalities, yet ethnic inequalities persist. Some ethnic inequalities of peer support among first responders can be seen as culturally incompetent peer support. This can be considered a peer who is not familiar with cultural practices or struggles that another has in their life based on the other person’s race, gender, sexuality, or religion (Bamrah et al., 2024). An example can be a peer who is of African American ethnicity who seeks peer support and receives peer support from a White male who has no shared experiences of discrimination or racial bias of their skin color. How can this ethnic inequality be addressed in peer support? By having a diverse group of peer supporters so that the person seeking peer support is able to receive peer support from the most appropriate person who has shared experiences, and if that means the person needing peer support wants their peer supporter to be the same ethnicity as them, then so be it, let another peer supporter who shares the same ethnicity as the person step in. After all, the goal of peer support is the well-being and growth of peers, not the self-entitlement, self-righteousness, or self-gratification one receives from helping another person.
The same can be said for a peer who may identify as part of the LGBTQ community, and there is no peer supporter on the team who is part of the LGBTQ community. In this case, one needs to be identified within the workplace to bring into the peer support team, or another peer support person with the same qualities, characteristics, and sexuality at another first responder agency can be contacted to step in and assist in helping this particular person.
Multiple branches of psychology, medicine, and other sciences address unique medical and scientific issues/conditions and populations of people seeking medical care. Some of these branches include specializing in geriatrics (older people), pediatrics, females, and males, and the unique challenges that certain races of people and people of differing sexualities face. Why does peer support among first responders not take the same approach? It does not take but a simple act of kindness and empathy by a first responder to start taking care of our own first responders in the realm of peer support and to take measures to ensure that peer support is culturally competent and seeks to help the peer in the way that they need help and not in the way that the peer supporter deems necessary, especially when that peer supporter does not know what it is like to live with racial biases and being a victim of racism, sexism, misogyny, or any other form of discrimination.
Addressing Ethnic Inequalities, Biases, and Oppression in Peer Support
When ethnic inequalities, biases, and oppression arise within peer support, they need to be addressed as soon as they are identified. Psychology addresses these things by advocating for equality over inequality and providing bias-free peer support and freedom instead of oppression (Bamrah et al., 2024). These changes come with research and education, cultural competence (which means adding peer supporters that are part of minority groups such as LGBTQ, Black, Latina/o, and so on), and also acknowledging where peer support has gone wrong and making right what has been wronged. First responders are a unique group that has unique problems and struggles, so when a first responder needs help, it is appropriate to have another first responder with the same ethnicity as the person needing peer support (if the person needing support wishes) and to realize that peer support is not about one person helping another, it is about helping a person in need in a way that helps them. It is not designed to let the peer supporters feel good about themselves for “helping” another person; it is about the person needing peer support and helping that person in the way that they need help.
Peer Support Among First Responders and the Relevance to the Field of Psychology
What do first responders and peer support have to do with psychology, and why is it relevant? First off, peer support is used in many areas of psychology, such as group counseling, Alcoholics Anonymous and Narcotics Anonymous groups, critical incident stress debriefings, and education. If a person is having trouble with something, whether it be mentally or physically, and someone offers them help, it not only gives the person that needs help the help that they need, it also elicits a feeling in the helper that they did something good for another person. This is called prosocial behavior and is rooted in psychology (Kakulte & Shaikh, 2023).
It is also relevant because the nature of a first responder’s job is to help others in their times of desperation when they need the most help, such as when someone is at risk of death, serious injury, or harm, and they even help people with matters that are not life-or-death problems. Who helps the first responders, though, when the stress of the job starts accumulating and causes acute stress, PTSD, or even causes the first responder to develop anxiety and depression if they did not already have it in the first place? Other first responders and those who understand and have shared experiences as first responders, such as emergency room nurses and doctors, military personnel, specialty-trained mental health professionals, and other high-stress occupations, are the ones who are best suited to help first responders when they need help (in a peer/social support manner). This is why psychology is relevant to first responder peer support and can be likened to the same way seeing a specially-trained doctor (cardiologist) for a heart attack is the best option for treating and healing after a heart attack or even seeing a neurologist for a stroke. If a person is having a heart attack or is afraid they are having a heart attack but really are not, they would want to see a doctor who is a specialist in diagnosing, treating, and taking care of people who have had or are currently having a heart attack. One would not call their dentist and see if they can fit into the schedule for the day after being in a car accident and think their leg is broken. No, they would go and see a doctor who is able to assess and treat all possible injuries from a car accident in the emergency room, including a broken leg, at the hospital.
Peer support needs to be looked at as an allied health role of psychology similar to how nurses, certified nursing assistants, physical therapists, x-ray technicians, billing and insurance workers, and many other roles are allied to the person that is in the role of a medical doctor. They assist the doctor in a specialized manner that, if they were not present to do their job, or were never a job in the first place, would make the doctor’s job a million times more stressful than it already is due to the increased workload that would be placed on the physician to do all of these other roles including their role as a doctor.
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How Theoretical Frameworks Shape Behavior and Action
Theoretical frameworks such as prosocial behavior (Kakulte & Shaikh, 2023), social support and peer support (Calhoun et al., 2022), and unconditional positive regard towards self and towards others (Murphy et al., 2017) help shape behavior and action by creating a concept, and a concept, or idea, cannot become a reality without action. The theoretical framework of the concepts just mentioned helps create the idea that helping others is a good thing and then helps a person to create ideas of how to help others. How does a first responder best help a person that they are called to help as a first responder? By continuing education, relying on the knowledge and skills they learned in their initial training, and applying those skills and knowledge to the current problem.
When there is a problem that a first responder cannot address because it is out of their scope of practice and beyond their skill set, they hand off the person to someone who is better trained, more knowledgeable, and has the skills to help, such as a paramedic who has a patient with signs of a heart attack and taking them to see a specialty trained doctor to best take care of, diagnose, and fix the problem. With this in mind, when a first responder is struggling with something in their personal life or within their mind, other first responders should gather together and support this first responder just like they would if it were a person they were called to help. If the problem is beyond the scope of social support and peer support, they would then help this person get in contact with a specialty-trained person (psychiatrist, psychologist, licensed counselor, chaplain, member of clergy, etc.) to help them. So, if the first responder who is struggling with something is struggling with depression, this may be able to be handled with peer support alone, but if the depression is severe to the point the person is thinking of self-harm, then they would hand off care to a specialty trained person such as a licensed mental health professional to better help them with the problem and receive therapy and even possibly medications for depression and anxiety.
Psychology’s Role in Advocating for the Greater Society and How it is Evident to Peer Support Among First Responders
Psychology as a whole, psychologists, licensed counselors, and other mental health professionals are advocates, professionals, and promoters of the well-being of others. This is evident in how mental health professionals engage in advocating for the rights of marginalized people, such as people of the LGBTQ community, victims of crime, victims of racial injustices and racism, and the moral and ethical treatment of people with mental disorders who are a part of society. What is the definition of society, you might ask? The American Psychological Association defines society as “an enduring social group living in a particular place whose members are mutually interdependent and share political and other institutions, laws and morals, and a common culture, any well-established group of individuals (humans or other animals) that typically obtains new members at least in part through sexual reproduction and has relatively self-sufficient systems of action, an organization formed for a particular purpose or to further a common interest or activity, and the companionship of other people” (APA Dictionary of Psychology, n.d.).
????? Based on this definition of society, are first responders not a part of society? They are a very important part of society, and the mental well-being of first responders needs to be advocated for (more so than it already is) and needs to be approached with the same seriousness as all other matters that are advocated for and promoted by psychology. This can be done in many ways. Advocating for the normalization of acute stress and how it affects people is already being done, but it needs to include how it especially affects first responders in a unique way. Promoting and advocating the importance of peer support and implementation of peer support resources, as well as having a licensed mental health professional overseeing the peer support for those instances where the person may need help beyond social/peer support, as described earlier.
It is disheartening and discouraging to know, as a first responder myself, how first responders take care and support others they are called and trained to help, but there are disparities and discrepancies when it comes to supporting ourselves and supporting other first responders. We must and can do better in supporting each other and increasing the salaries of first responders to ease the stress of staffing shortages (Nrp, 2024) and providing higher-quality education (Bevan et al., 2022) to increase the knowledge and well-being of first responders can help but is not a solution.
Many studies prove that people in supportive work environments who feel supported by their coworkers, supervisors, and other managers are happier with their place of employment, have increased job satisfaction, and have lower levels of burnout and perceived stress than those who are in a non-supportive work environment. What better way is there to implement a supportive work environment than actually to practice supporting each other through peer support? Does money support someone? For a very short period, money might help, but not long-term. Does mandating better education make someone feel supported? No, it makes the person feel like they are not doing a good enough job and need to do more in order to do a good job. It implies that one is not performing adequately enough and is not supportive. This is not to say that these two things are not helpful and are wrong; it is simply to put in perspective how important peer support and a supportive work environment really is.
Concluding Statement
Peer support among first responders should be a top priority for first responder agencies, first responder supervisors or managers, and those who live, love, or are married to a first responder. After providing evidence of what peer support is and how it is not being approached effectively by employers for those needing peer support, and providing the evidence of peer support among first responders being essential for overcoming stressors related to their jobs, it probably raises many questions of how to create or reconstruct a peer support team that is already being used to serve its peers better. No one way is perfect for every single person, and peer support needs to be approached in a personalized manner that helps the person seeking peer support (Feuer, 2021). Being kind, supportive, and showing compassion for your peers is the first step in effective peer support. When a peer needs help, regardless of the reason, be “here for your peer,” and instead of wanting and asking for change, be the change (Horan et al., 2021).
References:
APA Dictionary of Psychology. (n.d.). https://dictionary.apa.org/society
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Nurse ??????/ Advocate ?? / Navigator ?? / Creator &?? Managing Director ?? of DrassAssociates.com ?? / MHS, MSN, RN, PMH-BC, NEA-BC, CLNC, NCC ?? /???? Professor/?? Behavioral Health??& Legal Nurse?? Consultant ??
2 周Dr. Orlando E Rivera DNP, MBA, RN, thought you might be interested in this excellent piece by David Speciale. ?? #strongtribessavelives
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3 周I published my PsyD dissertation on peer support utilization and stigma last year. The results were interesting in that the newer police and fire fighters had more open views towards mental health and peer support than the older generation.
Licensed Clinical Social Worker/Psychotherapist in Private Practice / Owner at PL Therapy, LLC/Writer & author
1 个月Very interesting stuff. Wondering your thoughts on the intersection of this topic with myths of masculinity...you mention the "suck it up" culture. Do you find that this is prevalent among male EMTs? I would think that a willingness to express emotion in such a difficult and possibly traumatizing job is important. I ask as a therapist who often works with men and has a special interest in challenging some of these masculine myths. Thanks for your contribution!
Clinical Program Director - The First Responder Behavioral Health Institute
1 个月How do you feel about the role of clinically directed peer support initiatives?