Mental Health for First Responders: Warning Signs and Support
Updated September 22, 2026
First responders face repeated trauma over a career, and it takes a measurable toll: SAMHSA reports an estimate that 30% develop behavioral health conditions, including depression and PTSD, compared with 20% of the general population. The job’s culture often discourages admitting to struggle, which makes early recognition critical. This guide covers the warning signs, what managers and loved ones can do, and where to find confidential support.
The following experts contributed to this guide: Lisa Alizadeh, LPC, and Misty Springmeyer, a former police officer.
Police officers, firefighters, and emergency services personnel are the first ones to arrive at the scene of an emergency. Often, they have no idea what they’ll encounter when they get there or what steps they will need to take. They have to assess the situation on the spot, make immediate decisions, and take swift action.
The job leaves a mark. SAMHSA reports an estimate that 30% of first responders develop behavioral health conditions, including depression and post-traumatic stress disorder (PTSD), compared with 20% of the general population.
This guide covers the specific causes of mental health issues for first responders, and what first responders, their managers, and their loved ones can do to recognize and address them.
Mental Health America (MHA) leads the annual “May Is Mental Health Month” campaign, encouraging everyone to take mental health screening seriously. MHA provides a free toolkit that anyone can use to improve mental health and build resilience, covering education, outreach, screening resources, and guidelines for sharing these messages on social media.
How you can help:
- Get screened using MHA’s free screening tools and encourage others to do so
- Share your story
- Get your employer involved using the guidelines in the toolkit
- Contact your elected officials about supporting mental health
- Start a fundraiser on social media
Why Are First Responders So Susceptible to Mental Health Issues?
The jobs of first responders are difficult and demanding, but so are many other jobs. Other professionals also deal with violence, suffering, injury, and death. Why, then, are first responders more likely to have mental health problems?
Misty Springmeyer, who was a police officer in California for 15 years and is currently an investigator for the Santa Clara District Attorney’s office, says: “The job absolutely affects our mental health. So many factors are involved with emotional stress from traumatic scenes, internal stress from a demanding job, stress of feeling unappreciated, and the physical stress of working long/odd hours. If you are not careful, it can easily negatively affect you.”
“First responders work in positions that expose them repeatedly to crisis, trauma, and emotional distress. Additionally, their roles typically require them to make significant and immediate decisions to address the problem and remain calm and alert throughout the entire process.”
– Lisa Alizadeh
A significant cause of stress is the unknown. When a call comes in, first responders often don’t know what they’ll find when they get to the scene. It might be a minor incident that can be easily resolved, or it could be a full-blown crisis that requires an immediate life-saving response or puts them in danger. They need to be ready for whatever comes their way.
Not every call is traumatic or upsetting, but it’s the cumulative stress that can be dangerous. No matter what type of emergency they’re handling, responders need to stay alert, and that state of awareness often spills into everyday life. As a 16-year police force veteran put it in an interview in 2019, “I can’t turn it off. The word for it is hypervigilance.”
First responders also carry the stigma of admitting to mental health struggles. “There is a culture and expectation that these individuals are to remain strong and in control, which can lead to them suppressing their own emotional and physical well-being in the process,” Alizadeh explains. A survey of nearly 7,000 career firefighters and paramedics by the International Association of Fire Fighters and two NBC stations found that 81% felt they would seem weak or unfit for duty if they asked for help.
This sentiment often goes all the way to the top. Many managers are uncomfortable hearing employees open up about their feelings, and the advice they got from their own managers was to “toughen up,” so they pass that sentiment down the chain. Springmeyer notes: “My employer provides mental health resources…[but] there is a stigma with asking for help in our profession. It is okay to express anger or frustration with calls/scenes, but not far beyond that.”
The result of this stigma is that first responders often don’t seek help. They try to ignore their distress or feel guilty for feeling it in the first place.
Mental Health Conditions Linked to First Responders
The pressure and intensity of a first responder’s job can manifest in various ways. The primary conditions they face include depression, PTSD, suicidal ideation and attempts, substance abuse, and complex or cumulative trauma.
Depression
It’s not unusual for a police officer to feel anxiety after encountering an armed suspect, an EMT to feel sadness at the loss of a life, or a firefighter to be discouraged after fire devastates homes and communities. When these feelings persist or get stronger over time, though, they can become a problem.
The Ruderman white paper cites depression estimates of about 11% among firefighters and 9%-31% among police officers, compared with 6.7% in the general population.
Depression can result in a lack of interest in daily activities, difficulty concentrating, sleeping too much or too little, and isolating oneself from others.
Post-Traumatic Stress Disorder
PTSD is a mental health issue that occurs after a trauma or series of traumas. It ranges from daily symptoms of mild depression or anxiety to severe negative reactions to specific triggers related to the trauma. The National Institute of Mental Health identifies these components of PTSD:
- Re-experiencing: Unexpected flashbacks or nightmares of a trauma, mirroring the same fear and physical responses, such as sweating and rapid breathing, felt during the event
- Hyperarousal: Feeling constantly on edge, being hypervigilant even in non-threatening situations, startling easily, and responding with inappropriate anger
- Avoidance: Feeling guilty and depressed (or having no feelings at all) about a past traumatic event, having difficulty remembering the event, and avoiding places, people, objects, or situations that might trigger memories of it.
- Cognitive and mood changes: Negative thoughts about oneself or the world, feeling extreme guilt or blame, and losing interest in activities that used to bring joy
PTSD can lead to all of the other conditions discussed here—depression, anxiety, suicidal tendencies, and substance abuse. Some studies cited by the Ruderman Family Foundation have found PTSD and depression rates among firefighters and police officers as much as five times higher than civilian rates.
A related issue is secondary traumatic stress (STS), which results from witnessing the suffering and trauma of others. Family members of first responders sometimes develop this condition. The symptoms are similar to those of PTSD. They include feeling numb or detached, feeling tired all the time, experiencing confusion and difficulty making decisions, a decrease in job performance, and closing oneself off from family and friends.
Suicidal Thoughts and Behaviors
When a person feels hopeless that they will ever overcome depression, nightmares, anxiety, fear, or other symptoms, their thoughts can turn to suicide. Lack of control in one’s life feeds that hopelessness, and first responders often have little control over the situations they face and, despite their best efforts, the outcomes.
Research has found that police officers and firefighters have, in some years, died by suicide more often than in the line of duty. Suicide counts among first responders are also believed to be underreported.
In a 2015 self-selected survey of 4,022 EMS and fire respondents by Fitch & Associates’ Ambulance Service Manager Program, 37% reported having contemplated suicide, nearly 10 times the rate of American adults, and 6.6% reported an attempt, compared with 0.5% of all adults.
Substance Abuse
Substance abuse is a coping response to many mental health issues. Alcohol abuse is a particularly frequent struggle for first responders, and binge drinking is more common among first responders than the general public. The 2018 Ruderman white paper reported that alcohol was present in more than 85% of police-officer suicides, citing personal communication with National Police Suicide Foundation founder Robert Douglas.
Complex (Cumulative) Trauma
Much of this article discusses the impact of individual traumatic events, but it’s often the cumulative effect that leads to mental health issues. Even if only a small proportion of 911 calls turn out to be traumatic, not knowing what will happen, day after day, month after month, year after year, can exact the same emotional toll as a single major crisis.
That’s why first responders need to check in with themselves regularly to make sure their cumulative experiences aren’t starting to wear on them.
Ways to Support the Mental Health of First Responders
There are many ways to reduce the prevalence of mental health issues for first responders. Some are things they can do for themselves; others are things managers and loved ones can do to help.
The following suggestions come from a variety of resources, including the Centers for Disease Control and Prevention (CDC), mental health professionals, and first responders themselves.
What First Responders Can Do
To take care of others, you have to take care of yourself first. Here are strategies you can use before, during, and after an emergency response.
Prepare yourself. Learn as much as you can about the event you’re responding to beforehand. When that isn’t possible, mentally prepare with positive affirmations (“This may be a bad one, but I can get through it”) or calming strategies like deep breathing and mindfulness. Apps such as Headspace and Calm (available on the App Store and Google Play) can help you build these habits.
Validate and manage your emotions. If you find yourself becoming rattled or stressed during a response, take a mental step back. Springmeyer says, “When responding to a traumatic scene, I remind myself that this is part of my job and that people are looking to me for help, strength, and calming. I have learned to keep my adrenaline and emotions in check. I definitely feel them coming, but can push them aside and focus on the task at hand.”
Watch for signs of burnout or stress. Get educated about the signs of burnout or more severe emotional distress, and stay self-aware. Notice changes in your actions and behaviors. Keeping a journal to track your mood and behaviors can help you stay in tune with yourself. Regular screening is one way to keep tabs. Mental Health America offers free mental-health screening tools for various conditions. These aren’t diagnostic, but they’re a useful gut check.
Find a support network. Peer support matters, but it isn’t always easy to talk to coworkers about mental health. If your employer doesn’t have a formal peer support policy, look outside of work. Numerous groups and organizations serve first responders specifically (see the resources below), and many run blogs, forums, or Facebook groups where you can connect.
Take care of yourself daily. Waiting until the weekend, or until that upcoming vacation, to unwind and deal with stress won’t cut it. Self-care has to be ongoing. Springmeyer shares, “Not bringing the job home can be more difficult some days than others. I rely on exercise as a major stress reliever. I exercise daily and use that time to focus on the positives in my life. If I had an especially hard day, I will talk about it with my husband after the kids have gone to bed. I focus on talking about it without dwelling.” Find an activity you enjoy and build it into your routine, whether that’s exercise, yoga, meditation, or simply taking time to self-reflect.
Seek professional help. You’ve probably heard this advice before, and it may feel like an extreme measure reserved for people in crisis. Try reframing it: seeking help is no different than calling a doctor to check out a physical ailment, and working with a mental health professional counts as preventative care. You already know from your work that early intervention leads to better outcomes.
What Managers Can Do
One of the most important things you can do as a manager of first responders is normalize mental health discussions. Alizadeh emphasizes, “Companies employing first responders should embrace and advocate the importance of emotional and physical health at all times.”
Focus on preparedness. The more first responders know about what they’re going to encounter, the more in control they feel. Give your team as much information as possible about their roles before responding, help them anticipate problems, and normalize the emotional challenges they might face.
Debrief. Taking time, even briefly, after a stressful event to let your team discuss what happened, ask questions, and share ideas can be critical to helping them process it and move forward.
Make mental health resources easy to find. Every first responder on your team should know your organization’s policies and protocols for mental health issues and have access to educational resources. “First responders must be educated and encouraged to assess their own mental health and physical needs by learning the warning signs and symptoms these individuals are often susceptible to due to the demands of their jobs,” Alizadeh stresses. Make sure they can get professional help anonymously, without having to come to your office to ask for it.
Institute the buddy system. Pairing two responders to support each other and monitor stress, workload, and safety helps institutionalize peer support, which matters most in environments where asking for help can otherwise feel threatening.
Provide training. Organizations such as the First Responder Center for Excellence offer stress-first-aid training for first responders and their managers. Programs such as Critical Incident Stress Management (CISM) provide ongoing education and management resources. Check the resources section below, and consider reaching out to other organizations in your area for local programs.
What Loved Ones Can Do
As a family member or loved one of a first responder, you’ve likely witnessed their sadness, anger, or emotional distress after a hard day. You’re often in a tough spot, trying to be supportive without suffocating them, and trying not to let their emotions weigh you down too. Here’s what you can do.
Be accepting and don’t judge. Stigma is bad enough when it comes from coworkers or management, but it can be devastating when it comes from a family member or close friend. Reactions like “Why are you still so upset about something that happened a month ago?” make people defensive and cause them to close up. If your loved one expresses concerns about their mental health, support them. “With encouragement and support from people they care about, first responders may feel less stigmatized to seek out and receive mental health treatment and support,” says Alizadeh.
Make mental health a priority. Discussing mental health should be routine, not something that only comes up in extreme situations. Alizadeh advises encouraging first responders to prioritize emotional and physical health in daily life, not just after a bad call.
Watch and listen. You know your first responder better than most people do. Look for changes in their emotional behavior or thinking over time, and consider keeping a journal to track what you see. Watch for signs of suicidal thoughts. The ACT method describes signs and how to respond to them.
Start a conversation. If you’re worried about changes you’ve noticed, say so, without accusation. A simple statement of what you’re observing works better than “You’re always down in the dumps these days!” Ask questions, let your loved one respond, and ask what THEY think they should do rather than telling them what to do. Validate whatever they share.
Take action. Listening and talking matter, but if your concerns keep growing and your loved one won’t take positive steps, you may need to act yourself. Talk to a mental health professional for advice.
Take care of yourself too. An article in Fire Rescue 1 calls the families of first responders “silent victims.” As former firefighter Nick Halmasy put it, “They walk this journey with us, but they are the silent victims when things don’t go so well.” You worry, you feel guilty asking for help because their needs seem greater than yours, and you lose sleep waiting for them to come home. Follow the same guidelines above for your own mental health. You’re important too.
Hope for the Future
The climate around mental health care is changing. At every level, efforts are underway to confront the stigma of mental health problems and address them the way we would any other illness.
The Law Enforcement Mental Health and Wellness Act of 2017 was signed into law on January 10, 2018, directing federal efforts to support and study law-enforcement mental-health and wellness programs.
Senators Jacky Rosen and Deb Fischer introduced the Helping Emergency Responders Overcome (HERO) Act on January 28, 2020. It was a bill, not enacted law, and has since been reintroduced. If passed, it would establish programs to monitor and support the mental health of law enforcement officers, firefighters, ambulance crew members, and 911 operators, including a public-safety officer suicide-reporting system at the CDC and peer-support wellness programs within departments.
States have moved too. In 2018, Massachusetts passed a law (Chapter 329 of the Acts of 2018) protecting the confidentiality of certain crisis-intervention communications for first responders who participate in support programs following a crisis, subject to statutory exceptions such as a threat of bodily harm or an admission of a crime.
Several other states, including Nebraska, New Mexico, and Virginia, have proposed bills to compensate first responders for medical treatment and to fund resiliency training. Workers’ compensation treatment of first-responder PTSD varies substantially by state, including differences in eligible occupations, qualifying events, proof requirements, and presumptions of work-related causation.
Organizations such as the National Alliance on Mental Illness (NAMI) and the International Association of Fire Fighters (IAFF) have led anti-stigma campaigns. The IAFF’s guidelines for firefighters include:
- Show empathy not only to the public but to each other
- Avoid stereotyping people, including crew members, who have a behavioral health disorder
- Explore peer support resources in your department
- Avoid unhelpful comparisons between fellow firefighters
- Embrace and empower others who choose to seek treatment
- Inform and educate the community about behavioral health
Police leadership has shifted too. In 2014, the International Association of Chiefs of Police released Breaking the Silence on Law Enforcement Suicides, which grew out of a 2013 IACP/COPS symposium. It outlines specific programs agencies can adopt and calls for a cultural shift “toward openness and support for all aspects of officer health and wellness, particularly mental health.”
Helplines
988 Suicide & Crisis Lifeline: Available 24/7 – Call or text 988
SAMHSA Disaster Distress Helpline: Available 24/7 – 1-800-985-5990
Safe Call Now: Available 24/7 with first responder call-takers – 1-206-459-3020
Fire/EMS Helpline: Available 24/7 – 1-888-731-3473
Copline (law enforcement only): Available 24/7 with police call-takers – 1-800-267-5463
Frontline Helpline: Available 24/7 with first responder call-takers – 1-866-676-7500
Resources
These resources are for first responders, their employers and loved ones, and anyone who wants to learn more about the mental health challenges first responders face and how to get help.
- Centers for Disease Control and Prevention (CDC), Emergency Preparedness and Response: Information about the signs of burnout and secondary traumatic stress, coping tips, and additional resources.
- Substance Abuse and Mental Health Services Administration (SAMHSA), First Responders and Disaster Responders Resource Portal: Signs of emotional distress, coping tips, and free online stress-management courses.
- First Responder Support Network: A searchable database of clinicians, support group meetings (in California), six-day retreat programs, and educational articles, books, and videos.
- First Responder Center for Excellence (FRCE): Resources on awareness, research results, and behavioral health training.
- The Code Green Campaign: Training courses, a resources database, and blogs aimed at reducing stigma and financial barriers to care.
- Next Rung: Peer support, help finding a counselor, and financial assistance for licensed counselor services.
- Mental Health First Aid: A course that helps family, friends, and coworkers of first responders identify and respond to signs of addiction and mental illness.
- International Association of Fire Fighters: General resources, guidelines for building peer support programs, and an interactive course to train peer counselors.
- Firefighter Behavioral Health Alliance (FBHA): Behavioral health workshops for fire, EMS, and dispatch organizations, focused on awareness and suicide prevention.
- Blue H.E.L.P.: Raises awareness of mental health and suicide, advocates for PTSD benefits, and honors officers lost to suicide.
- National Police Suicide Foundation (NPSF): Dedicated to reducing suicide in law enforcement through education and peer support.
Frequently Asked Questions
What mental health conditions are most common among first responders?
Depression, PTSD, and substance abuse show up most often, frequently layered on top of each other. The Ruderman Family Foundation’s white paper puts depression at roughly 11% among firefighters and 9%-31% among police, and some of its cited studies find PTSD and depression rates in firefighters and police as much as five times civilian rates.
Why don’t more first responders ask for help?
Stigma is the biggest barrier. A survey of nearly 7,000 career firefighters and paramedics found that 81% worried asking for help would make them look weak or unfit for duty. That pressure often comes from managers who were told the same thing earlier in their own careers.
What can a department or manager do to support mental health?
Normalize the conversation before a crisis hits: brief teams on what to expect before a response, debrief after stressful calls, make anonymous help easy to find, pair responders in a buddy system, and provide stress first aid or CISM training.
Where can a first responder get confidential help right now?
The 988 Suicide & Crisis Lifeline and the helplines above, including Copline for law enforcement and the Fire/EMS Helpline, are staffed specifically for first responders and are available 24/7. Free screening tools from Mental Health America can also help identify what’s going on before you talk to someone.
Key Takeaways
- The risk is real and measurable – SAMHSA estimates 30% of first responders develop behavioral health conditions such as depression or PTSD, compared to 20% of the general population.
- Stigma, not lack of resources, is usually the barrier – most departments have some mental health resources, but a culture of “toughen up” keeps people from using them.
- Cumulative stress matters as much as single incidents – you don’t need one dramatic call to develop PTSD or complex trauma. The daily grind adds up.
- Managers and loved ones have real leverage – debriefs, buddy systems, and simply not judging a bad day can change whether someone asks for help.
- Confidential, first-responder-specific helplines exist – 988, Copline, the Fire/EMS Helpline, and Safe Call Now are staffed by people who understand the job.
If something in this guide sounds like where you are right now, don’t wait for it to get worse before reaching out. The helplines above are staffed specifically for people in this line of work, and calling one is a first step, not a last resort.
Meet the Experts
Lisa Alizadeh, LPC
Lisa Alizadeh has more than a decade of experience providing therapy and psychological services to children and families in schools, hospitals, and outpatient settings. She holds a master’s degree in clinical psychology and a professional counseling license (requirements and titles for this credential vary by state). She has written for several research publications within the field of psychology. In her spare time, Lisa enjoys playing with her toddler and husband, recreational soccer, and living a healthy vegan lifestyle.
Misty Springmeyer
Misty Springmeyer was a police officer in California for 15 years. She is currently an investigator for the District Attorney’s Office of Santa Clara County. She is assigned to Family Crimes, which covers sexual assault, child abuse, elder abuse, and domestic violence.