October 2, 2023

Destigmatizing the Conversation: The Crucial Role of Critical Incident Stress Management for First Responders


Chief Operations Officer, Crisis Response Canines

October marks the National Depression and Mental Health Awareness and Screening Month.  While depression can affect anyone, it has a particularly profound impact on First Responders. Now more than ever, we have a call to action to raise awareness, and address the mental health needs of our heroic first responders. Critical Incident Stress Management plays a crucial role in supporting their mental health and general wellbeing.

It is widely known that First Responders have exceedingly dangerous and stressful jobs. The daily exposure to traumatic events and the cumulative effects of Post-Traumatic Stress Injuries (PTSIs) takes a toll on physical and mental health. First responders are often regarded as heroes, yet are not immune to the struggles of depression. The unique challenges they face in their line of duty can contribute to the development and exacerbation of stress and depression symptoms. Constant exposure to traumatic events, long hours, shift work, and the pressure to make life-altering decisions can create a perfect storm for mental health issues.

This may manifest in anxiety disorders, relationship issues, substance abuse, depression, and suicidal ideation. Rates of depression among these professions approaches 5 times that of civilians. There is up to a 54% increase in suicide risk as compared to others. More first responders die by their own hand than in the line of duty (and this is likely underreported as the suicides occur among retirees, are sometimes covered up to protect the image of the lost loved one, or attributed to other causes). Unfortunately, there is no shortage of stories of lives lost of heroes who thought there was no other alternative. Also unfortunate is the fact that depression and suicide remain topics few want to discuss.

Critical Incident Stress Management (CISM) is a comprehensive, evidence-based approach aimed at helping first responders cope with the psychological effects of their challenging work. It involves a range of interventions and support systems designed to mitigate the impact of critical incidents and promote resilience.  Studies into the effectiveness of these interventions indicate that when utilized by trained operatives, the positive outcomes include reduced depression, alcohol dependence, anxiety and mitigation of PTSIs.

The concept of accepting the consequences of the daily exposure as a “Burden of the Badge” needs to be dispelled. First Responders have shared that if they seek help, they will be labeled “unfit for duty” or seen as weak. When suicides among colleagues do occur, shame and stigma often lead to silence or secrecy about the event, thus preventing an opportunity to process the event.  It is during these Critical Incident Stress Debriefings that trained peers openly discuss events, and the physical and emotional aftermath. It is imperative that these debriefings are integrated into standard operations when critical incidents occur. This proactive approach helps to normalize these heretofore difficult conversations.

There is an opportunity to take this month to collectively focus on educating the first responder community and the public about the mental health struggles of first responders. It is a time to destigmatize the conversations that must be had.  We have a unique opportunity to share stories, statistics, and resources to increase awareness. We can promote education and training to increase the number of available CISM teams who can provide peer support.

Mental Health Awareness Month is a crucial reminder of the need to prioritize mental well-being for everyone, including our dedicated first responders. As we acknowledge their unwavering commitment to our safety, we must also recognize the toll their duties can take on their mental health. By promoting Critical Incident Stress Management and supporting initiatives that aim to reduce the stigma around mental health, we can help ensure that those who risk their lives for our communities receive the care and support they deserve. This May, let’s make mental health a priority for our first responders, so they can continue to serve and protect us with strength and resilience.


Boscarino JA, Adams RE, Foa EB, Landrigan P. J. (2006). A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: implications for intervention and research. Medical Care, 44(5), 454–462.

Everly, G. S., Jr., & Boyle, S. H. (1999). Critical Incident Stress Debriefing (CISD): A meta-analysis. International Journal of Emergency Mental Health, 1(3), 165–168.

Everly, G.S. & Mitchell, J.T. (1997). Critical incident stress management (CISM):A new era and standard of care in crisis intervention. Chevron.

Everly G. S., Jr., & Mitchell J. T. (1999). Critical incident stress management, (2nd ed.). Chevron.

Heyman, M., Dill, J., & Douglas, R. (2018) The ruderman white paper on mental health and suicide of FRs. Ruderman Family Foundation.

National Institute of Mental Health, U.S. Department of Health and Human Services. (2021)Suicide.

International Association of Chiefs of Police. (2020) Preventing Suicide among Law Enforcement Officers: An Issue Brief. Education Development Center,

September 26, 2023

September 8, 2023

Police Organization Providing Peer Assistance (POPPA) Reflects on 9/11 and Introduces its Suicide Awareness for Emergency Responders (S.A.F.E.R.) Training

By Jennifer Taylor, Ph.D., Clinical Advisor, POPPA, Inc.

POPPA was just in its 5th year when 9/11 happened.  In the immediate aftermath of 9/11, PSOs and clinicians, familiar with CISM, provided coordinated emergency mental health services at Ground Zero and established a temporary crisis center at the nearby Federal Reserve Bank.

8 MTA workers honored as heroes for role in 9/11 response

By Kendall Green, MTA, FOX 5 NY

NEW YORK CITY- As we near the 22nd anniversary of 9/11 where pandemonium broke out, leaving thousands in hysteria, Transport Workers Union Local 100 honored. Watch Here

How the New 988 Lifeline Is Helping Millions in Mental Health Crisis

By Melissa Suran, PhD, MSJ

Every 11 minutes, someone in the US dies by suicide. That grim statistic, from 2021, reflects a 36% increase in suicide rates over the previous 2 decades.. Read More Here

September 8, 2023

Police Organization Providing Peer Assistance (POPPA) Reflects on 9/11 and

Introduces its Suicide Awareness for Emergency Responders (S.A.F.E.R.) Training

By Jennifer Taylor, Ph.D., Clinical Advisor, POPPA, Inc.

POPPA is a confidential, independent, non-departmental, peer-based assistance program for the NYPD, designed to respond to the psychological and mental health needs of NYPD officers.  All services within POPPA are provided to NYC police officers free-of-charge. 

The backbone of POPPA is its more than 200 volunteer Peer Support Officers (PSOs) drawn from all ranks of the NYPD.  These officers receive extensive 8-day training by POPPA on peer support and screening for safety issues, substance abuse, and mental health issues such as depression, anxiety, and PTSD.  POPPA also provides ongoing and semi-annual training and self-care support groups for its PSOs.  PSOs work in conjunction with a network of independent mental health clinicians who provide guidance and expertise. 

POPPA has used CISM protocols in several of its programs.  These include our 24-hour Helplines, Trauma Response Teams (TRTs) that conduct diffusings — responding immediately to critical or traumatic incidents, and follow-up critical incident stress debriefings (CISD).  POPPA goes out on hundreds of calls each year.  The debriefings have enhanced our ability to identify signs of distress and to respond by offering services and making appropriate referrals for these officers.  Information that officers share during debriefings have helped guide the expansion of POPPA services.  We now periodically offer our 2-day workshop/seminars.  These events include a debriefing component as well as health and self-care and interpersonal effectiveness strategies designed to bolster officer resiliency.  

POPPA was just in its 5th year when 9/11 happened.  In the immediate aftermath of 9/11, PSOs and clinicians, familiar with CISM, provided coordinated emergency mental health services at Ground Zero and established a temporary crisis center at the nearby Federal Reserve Bank.  Several ICISF-sponsored CISM teams from across the US and around the world came to work with POPPA at Ground Zero.1  Large numbers of officers, arranged in small groups, underwent defusings and debriefings to help process their experiences and by late September 2001, POPPA was providing services to nearly 100 officers daily.2  From December 2002 to December 2003, POPPA screened 28,232 NYPD officers (approximately 73% of the estimated 39,000 NYPD force) for the ongoing impact of the events of 9/11.  Over 68% of officers reported at least one ongoing behavioral, emotional, physical, or cognitive 9/11-related stress symptom 15-27 months after the attacks.3 This demonstrates the importance of responding to the emotional and psychological effects of exposure to traumatic events and the potentially devastating impact of cumulative traumatic exposures on police. 

The impetus for the development of POPPA was the shocking increase in suicides within the NYPD in 1993, 1994 and 1995.  With the exceptions of the deaths of 23 NYPD officers on 9/11, the ever-increasing numbers of 9/11 health-related NYPD deaths, and COVID-19-related NYPD deaths, the rate of suicide among NYPD officers is typically at least 2-3 times that of line-of-duty deaths annually.  This heart-breaking reality – that suicide exceeds line-of-duty deaths nationwide every year has led POPPA to develop its own Suicide Awareness for Emergency Responders (S.A.F.E.R.) program.   

The S.A.F.E.R. program helps to identify warning signs of suicidality and to respond effectively and compassionately to get the officer in distress appropriate professional help.  POPPA has conducted S.A.F.E.R. training for its own PSOs, as well as for NYPD peer support officers, active-duty NYPD officers, and has offered this training to surrounding agencies and police departments beyond the NYC area.  This training, like all POPPA services, is provided free-of-charge.

With gratitude for the work that the ICISF does and the collaboration between ICISF and POPPA, we would like to extend an offer for free S.A.F.E.R. training to emergency responders and clinical personnel as our guests.  If you are interested, please contact John Petrullo at 917 416-6558.


  1. Levenson RL, Jr. and Acosta JK.  Observations from Ground Zero at the World Trade Center in New York City, Part I.  International Journal of Emergency Mental Health 2001 3(4), pp. 241-244.
  2. Silver Award:  The Child and Adolescent Services Program of the World Trade Center Healing Services, Saint Vincent Catholic Medical Centers, New York – Providing Trauma-Related Treatment to Students After the Terrorist Attacks of September 11, 2001, and Other Traumatic Events.  2005 APA Silver Achievement Awards.  Psychiatric Services, October 2005: Vol. 56: No 10.  Pp. 1309-1312.
  3. 3. Dowling FG, Moynihan G, Genet B, and Lewis J.  A Peer-Based Assistance Program for Officers with the New York City Police Department:  Report of the Effects of Sept. 11, 2001.  Am J Psychiatry 2006; 163:151-153.

For more information check out their website! 

August 11, 2023

You Are Psychologically Stronger Than You Think

By: George S. Everly, Jr. PhD, ABPP, FACLP, CISM

“There is a dangerous myth that is virtually endemic in today’s society, and it hampers happiness, success, and growth. The myth states that human beings are inherently fragile and that the only way to be happy and successful in life is to protect oneself by avoiding adversity.”

Image Courtesy of terimakasih0 / Pixabay

In Times of Distress, It’s Really OK to Ask for Help

By: Dr. George Everly, Jr. PhD, ABPP, FACLP in Psychology Today

Seeking assistance in times of distress is an imperative, not a luxury. Read it Here

CISM: Fostering Resilience in Rural Montana

By: Teresa Majerus

“Over the past several years, agricultural reports have focused on the mental health of farmers and ranchers as they experience the economical and emotional impacts of the drought.” Read it Here

6 Essential Ingredients for Resilience

By: Mike Taigman, Kevin Hammond and Jurie Rossouw

“Resilience is the ability to advance in life despite adversity. It’s not just bouncing back from bad situations. It’s about thriving and living your best life through anything. Resilience is the essence of mental and physical health.” Read it Here

Weekly Wellness Minute: Increase Your Effectiveness and Happiness with One Simple Question

Presented by Lighthouse Health and Wellness. Watch here.

The Call: Stories from Behind the Badge Podcast

From The 100 Club of Arizona. Listen here.

PTSD911 Documentary

Viewing dates are listed here.

July 5, 2023

In July we recognize National Air Traffic Controller Day, which honors those who keep us all safe as we travel by air.  Recently the work of Air Traffic Controllers has been in the news with reports of multiple near misses in the skies.  The stress of this occupation is similar to those of our first responders, and the rate of PTSD is climbing. We also take time to recognize the stress felt by 911 dispatchers, often the “first” first responder to participate in a critical event. Let’s thank all of our heroes, and acknowledge all the stress they face while keeping us all safe.


National Air Traffic Control Day

Looking at 911 mental health calls in a new way

In a crisis, you depend on Pierce County 911 dispatchers. They deserve a break | Opinion

Editorial: Classify 911 operators as first responders

Peer-to-peer mental health program for first responders expands to cops

Helping Heroes: Preventing PTSD in first responders

June 23, 2023
This Posttraumatic Stress Disorder Awareness Day, we’ve included some words about Posttraumatic Stress Disorder (PTSD) and Posttraumatic Stress Injury (PTSI) from one of ICISF’s Co-Founders, Dr. George Everly, along with a variety of resources to help you and your peers.
Postttaumatic stress (PTS) is an intense stress reaction that many people experience after being exposed to a traumatic event.  PTS is perhaps best thought of as a form of psychological survival mechanism akin to the fight or flight response.
Postttaumatic Stress Disorder (PTSD) however is a more severe version of that same stress reaction. PTSD arises when that stress reaction interferes with one’s personal and or professional life. In my opinion, PTSD is best thought of as a stress injury, not a disorder. As such it should be renamed Postttaumatic Stress Injury or PTSI. 
Because PTSD/PTSI is a stress reaction, the use of an integrated continuum of services such as CISM with its peer support focus is indicated and should be employed in any organization that puts its personnel in harms way for psychological stress related injury.
George S. Everly, Jr., PhD, CCISM (ICISF Co-Founder)

10% Discount on Psychological Body Armor™

Your Bookstore for CISM Resources, offers a 10% discount on Dr. Everly’s Field Guide “Psychological Body Armor™“! The goal of this book is to reduce the risk of psychological injury, much the same as physical body armor reduces the risk of physical injury.

Additional Resources

PTSD911 Documentary Film: Shining a Light on PTSD & First Responders (Conrad Weaver)

Listen as we speak with guest speaker Conrad Weaver on “PTSD911 Documentary Film: Shining a Light on PTSD & First Responders”.

June 15, 2023

During the month of June, we recognize the importance of spreading awareness related to PTSD. It is a mental health issue that can impact anyone of any age after experiencing or witnessing a traumatic event-one of physical violence, military combat, natural disasters, or a severe accident.  PTSD may disrupt relationships, cause problems at work, or leave one feeling anxious, depressed, angry and isolated. The good news is that it’s treatable using various therapy techniques and medications.  There is hope and there is help.

Post Traumatic Stress Disorder can impact anyone

PTSD Awareness Month: ‘Get treated. It doesn’t get better with time’

Do something:’ Ukraine works to heal soldiers’ mental scars

Veterans face a new crisis at home. First responders can help.

Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State

Living with PTSD and the Battles that Come with PTSD for Veterans and More

Crosbyton police officer speaks on importance of helping first responders deal with trauma


May 17, 2023

May is national mental health awareness month and National Military Appreciation month.  We also acknowledge International Firefighter’s Day, National Police week, and EMS week.  We have so many military and first responders keeping us safe, we owe it to them all to support their mental health, as well as our own.

Breaking silence: Shattering the taboo of mental health

Supporting Veterans This Memorial Day

Editorial: We Should be There for First Responders

Officer Self-Sabotage

Securing the mental health of first responders

Mental Health for Those Who Help Others