Let’s start with a stark reality: approximately one-third of all first responders may develop PTSD. That’s significantly higher than the general population. Even more alarming? Studies show that 37% of fire and EMS professionals have contemplated suicide – nearly ten times the rate of the general population. And while 0.5% of civilians report attempting suicide, that number jumps to 6.6% among fire and EMS professionals.
These aren’t just statistics. They represent real people behind the uniform – your colleagues, your partners, maybe even you. The stigma around mental health in first response is real, persistent, and potentially deadly.
But here’s what’s interesting: while stigma remains a serious concern, it may not actually the biggest barrier keeping first responders from seeking help.
Beyond the Stigma: Why First Responders May Really Hesitate to Seek Help
As psychologist Dr. Annie Tanasugarn explains in her recent research, while society has made significant progress in reducing mental health stigma, other factors play an even bigger role in preventing people from reaching out.
The Trust Factor: When Betrayal Creates Barriers
Dr. Tanasugarn identifies betrayal as the most significant barrier that prevents trauma survivors from seeking help. In the high-stakes world of emergency response, this takes on added complexity. When you’ve dedicated your life to helping others while operating in a system that promises to “have your back,” experiencing betrayal – whether from leadership, partners, or the system itself – can leave deep psychological wounds.
Trust isn’t just about interpersonal relationships in emergency services – it’s quite literally a matter of survival. You need to trust your equipment will work, your backup will arrive, and your team will be there when you need them. When that trust is broken, whether through administrative decisions, organizational failures, or personal betrayals, it doesn’t just affect that specific relationship – it can fundamentally alter how you approach all future relationships, including those with mental health professionals.
The impact runs deeper than just reluctance to seek help. Betrayal trauma can trigger symptoms similar to physical threat responses: anxiety, hypervigilance, and difficulty regulating emotions. For first responders, who already operate in high-stress environments, these symptoms can be particularly devastating to both personal wellbeing and job performance.
Perhaps most critically, betrayal in a first responder setting often comes with an added layer of complexity: you’re trained to be the helper, not the one asking for help. When the systems or people meant to support you have let you down, it can make reaching out feel not just difficult, but impossible.
The Hidden Impact of Shame
Dr. Tanasugarn identifies shame as a critical barrier to seeking help, and in the first responder community, this takes on a unique dimension. Shame isn’t just about feeling bad – it’s about believing there’s something fundamentally wrong with being affected by the trauma you encounter. In a culture that prizes mental toughness and resilience, acknowledging emotional struggles can feel like admitting weakness or failure.
Therapist Kimberley Milton explains how this creates a dangerous cycle: “When you feel ashamed of something, the last thing you want is for the action behind that shame to be brought to light.” For first responders, this often means hiding vulnerabilities and distancing yourself from potential support systems. Milton notes that this isolation can be particularly destructive because “people who care about you will often be the first to encourage getting help or seeking mental health treatment.”
The impact goes deeper. As Milton explains, “People who deal with shame also often deal with depression and a low sense of self-worth. Both of those issues can make it harder to seek out help.” For first responders, this might manifest as pushing through difficult calls without processing them, believing you don’t deserve support, or convincing yourself that others have it worse.
But here’s the crucial distinction Dr. Tanasugarn emphasizes: the shame isn’t yours to carry. Milton suggests that healing begins with “commit[ting] to relationships with safe people” and understanding that “the more you start to open up about what you’re feeling, the more you’ll be in control.” Just as you wouldn’t feel ashamed of a physical injury sustained on the job, there’s no shame in being impacted by the psychological weight of what you witness and handle. Seeking help isn’t a sign of weakness – it’s a professional acknowledgment that mental health is as crucial to job performance as physical fitness.
Breaking the Cycle of Learned Helplessness
Dr. Tanasugarn’s research highlights a critical psychological barrier called “learned helplessness” – a state where, after repeated exposure to traumatic events or challenging situations, you stop believing that positive change is possible. As she explains, learned helplessness is where a person “gives up” trying to escape or free themselves from negative situations, even when solutions exist. For first responders, this might manifest as believing that feeling traumatized is just “part of the job” or that nothing can help improve your mental state.
This mindset is particularly dangerous in emergency services, where each shift brings new potential for traumatic experiences. When you’re constantly moving from one critical incident to another without adequate time to process and recover, it’s easy to fall into this pattern of thinking. According to research, nearly 69% of EMS professionals report never having enough time to recover between traumatic events, creating a perfect storm for learned helplessness to take root.
The good news is that, just like physical conditioning, mental resilience can be rebuilt with the right support and tools. Breaking free from learned helplessness starts with recognizing that while you can’t control the incidents you respond to, you can control how you process and cope with them.
Physical Injuries vs. Emotional Trauma: Breaking Down the Double Standard
Think about it: If you injured your knee on a call, you wouldn’t think twice about seeing a doctor. Emotional trauma deserves the same level of professional attention. It’s an actual injury to your brain and spirit, affecting how you process experiences and perform your duties.
Signs It’s Time to Reach Out
- Sleep disturbances or nightmares about calls
- Feeling emotionally numb or disconnected
- Increased irritability with family or colleagues
- Changes in appetite or energy levels
- Difficulty concentrating during shifts
- Using alcohol or other substances to cope
Taking the First Step
Remember what Dr. Tanasugarn emphasizes: “Getting to a place of feeling comfortable talking about our lived experiences isn’t an overnight fix.” You don’t have to figure this out alone. Just like you have specialized training for your job, there are mental health professionals specially trained to work with first responders.
Resources That Understand
- First Responder-specific counseling services
- Peer support programs
- Crisis lines dedicated to emergency service personnel
- Employee Assistance Programs (EAPs)
- Department chaplains or mental health liaisons
The Bottom Line
Your mental health isn’t just about you – it affects your performance, your team’s safety, and the quality of care you provide to others. As Dr. Tanasugarn points out, healing takes time and requires “compassion, understanding, and allowing a person space to process their grief.”
You wouldn’t send a colleague into a dangerous situation without backup. Don’t face emotional challenges without support either. The job requires you to be at your best – mentally and physically. Taking care of your mental health isn’t just okay – it’s an essential part of being an effective first responder.
Have you found ways to overcome barriers to seeking help? Your story could help other first responders take that first step. Share your experiences in the comments below.
[Note: This article references research by Dr. Annie Tanasugarn, PhD, published in Invisible Illness, February 2022 and information from therapist Kimberley Milton published on Mental Health Match ]