Destigmatizing the Conversation: The Crucial Role of Critical Incident Stress Management for First Responders
By: John Hunt, MA, CHEC, CCISM, CAAIS
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.
References:
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. https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First%20Responder%20White%20Paper_Final%20(2).pdf
National Institute of Mental Health, U.S. Department of Health and Human Services. (2021)Suicide. https://www.nimh.nih.gov/health/statistics/suicide.
International Association of Chiefs of Police. (2020) Preventing Suicide among Law Enforcement Officers: An Issue Brief. Education Development Center, https://edc.org/sites/default/files/uploads/NOSI-Issue-Brief.pdf.
September 26, 2023