Running Head: MENTAL HEALTHCARE IN UTAH’S FIRST RESPONDERS 1

First Responders:

Issues Regarding Mental Healthcare In Utah's First Responders

Westminster College

PUBH*340*01

Jane Horne, Brenna Verboncoeur, & Gabrielle Pantages

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Prevalence of Mental Health Issues in Utah’s First Responders​:

Mental health should be seen as a priority in the healthcare system but the issue is, not

everyone has access or can afford to take the time to care for their mental health, especially first

responders. More information has recently been released surrounding the prevalence of the

mental health predicament for the first responders in Utah. Lawmakers are requesting funds for

mental health resources to be distributed across the state for these frontline workers. Their

mental health is very important to continue their ability to help people in Utah.

According to the article, “The effects of emergency medical service work on the

psychological, physical, and social well-being of ambulance personnel: a systematic review of

qualitative research” first responders ​are defined as: paramedics, emergency medical technicians,

emergency medical personnel, emergency dispatch personnel and call-takers. They take on the

role of directly providing and coordinating the communication of response for out-of-hospital or

pre-hospital emergency medical care in the community. The article argues that first responders

are “the forgotten profession within the healthcare system” (​Lawn, Roberts, Willis, Couzner,

Mohammadi., & Goble, 2020)​.

First responders reported a high incidence of mental distress, mental illness, and the

associated physical effects of psychological injury (​Lawn, Roberts, Willis, Couzner,

Mohammadi, & Goble, 2020)​. The authors of this article conducted a study to see the prevalence

of mental health within the first responder community. The study consisted of quantitative

research that looked at 27 international studies which consisted of 30,878 first responders. They

discovered an estimated prevalence rate of “11% for post-traumatic stress (PTS), 15% for

depression, 15% for anxiety, and 27% for general psychological distress among ambulance

personnel” (​Lawn, Roberts, Willis, Couzner, Mohammadi, & Goble, 2020).

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The physiological symptoms reported by first responders include headaches, sleep

disruption, musculoskeletal injuries, fatigue, dietary problems, weight gain and rare exposure to

dangerous pathogens (Lawn, Roberts, Willis, Couzner, Mohammadi, & Goble, 2020). These

symptoms can inhibit the work of these first responders and can negatively affect their work and

lives. The article came to the conclusion that “there is sufficient evidence within the research

literature to suggest that these metrics are detrimental to the mental and physical health and

well-being of ambulance personnel” (Lawn, Roberts, Willis, Couzner, Mohammadi, & Goble,

2020).

Utah’s incidence in the mental health patients has been increasing over the years. A KSL

news article quoted ​Representative Karen Kwan, D-Murray, ​saying ​"We have seen an increase in

mental health needs ... but especially for our first responders, we have not seen the expansion in

the kinds of programs that are specific to them." (​Imlay, 2021). This shows that more research

needs to be conducted surrounding this issue and more resources need to be provided for this

population. Our first responders are very important to public health safety. Therefore, it is of

obvious concern to all, that money be spent to protect their mental health.

Effects of Mental Health on First Responders:

First responders are often negatively affected by their high stress jobs. According to The

Substance Abuse and Mental Health Services Administration branch of the U.S. Department of

Health and Human Services, “First responders are usually the first on the scene to face

challenging, dangerous, and draining situations. They are also the first to reach out to disaster

survivors and provide emotional and physical support to them. These duties, although essential

to the entire community, are strenuous to first responders and with time put them at an increased
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risk of trauma.” (SAMHSA, 2018). The article, “First Responders: Behavioral Health Concerns,

Emergency Response, and Trauma”, published in May of 2018 said that an estimated 30 percent

of first responders develop behavioral health conditions like, depression and posttraumatic stress

disorder (PTSD), compared to 20 percent in the general population (SAMHSA, 2018). First

responders also reported to have higher attempt and ideation rates.

Depression is a symptom reported by a majority of emergency medical service personnel

and has been cited in many articles related to this subject. They also report symptoms of sucidide

ideation, Post Traumatic Stress Disorder (PTSD), substance abuse, which can all impede on their

work and home life. According to the SAMHSA article over 50 percent of firefighter deaths are

due to stress and exhaustion (SAMHSA, 2018). They also found that career firefighters reported

higher levels of “problematic alcohol use and PTSD as compared to the volunteer firefighters,

while the volunteers reported higher levels of depression and suicide attempts and ideations”

(SAMHSA, 2018). Many first responders reportedly binge-drink and use illegal substances as a

coping mechanism.

Suicide ideation is considered thinking about and planning on committing suicide. Within

the 1,027 firefighters in the U.S., current and retired, it is estimated that 46.8 percent, 19.2

percent, and 15.5 percent of firefighters reported suicidal ideation, plans, and attempts

(SAMHSA, 2018). The news article, “More First Responders Dying by Suicide than in Line of

Duty”, reported that there were more than 200 reported officer suicides and 133 confirmed

firefighter deaths across the nation in 2019 (GERRISH, 2020).

The article, “First Responders: Mental Health Consequences of Natural and

Human-Made Disasters for Public Health and Public Safety Workers” gives a good public-health

based assessment of the mental effects seen in first responders by reviewing epidemiological
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studies that “broaden our understanding of the range of health and mental-health consequences

for first responders” and by applying “public health intervention models for the assessment and

management of distress responses and mental disorders in first-responder communities”

(​Benedek, Fullerton, & Ursano, 2007).

This article identifies first responders as “police, firefighters, search and rescue

personnel, and emergency and paramedical teams”, which are “included in most definitions and

have been studied most extensively” (Benedek, Fullerton, & Ursano, 2007). “However, nurses,

physicians, laboratory personnel, and ancillary hospital staff have also played important roles in

the responses to recent natural disasters in the United States and abroad, in rescue and recovery

operations after terrorist attacks, and in the identification, management, and treatment of

infectious outbreaks such as SARS”, or such as with the COVID-19 pandemic (Benedek,

Fullerton, & Ursano, 2007).

The article goes on to discuss “the potential negative emotional consequence of disaster

work resulting from exposures to traumatic events, high levels of work demand, work with

disrupted communities and evacuee populations, and separation from home and loved ones”,

which we have discovered is often manifested as PTSD, ASD, or acute stress disorder,

depression, somatization, subclinical emotional symptoms, such as fear, distress, and worry,

disturbed sleep or concentration, alterations in work function, difficulties with interpersonal

relationships, and altered health risk behaviors, such as substance abuse, throughout the articles

and in all of the research on this subject (Benedek, Fullerton, & Ursano, 2007).

Current Policies and Relationship with First Responders

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Policies regarding mental health concerns for first responders are a responsibility given to

each state; because of this, there are no nation-wide policies currently implaced. Although in

recent years this topic has become more heavily discussed in the political realm, often the

development and upkeep of any such “policies” are left to the individual organizations

themselves. This leaves a severe lack of accountability in terms of useful programs and policies,

and taking seriously the severe mental health implications of first responders jobs. In Utah, this

is an issue that the last two years of legislative sessions have highlighted; this year in particular,

several articles regarding mental health in the first responder realm have surfaced on news

resources like KSL, bringing media spotlight to a previously shadowed topic.

Two main legislative pieces were brought to the table, in a somewhat combined format:

H.B. 0025 and H.B. 0248. This first bill is an extension of the “Mental Health Protections for

First Responders Workgroup” for another five years, to end in 2025. This workgroup, consisting

of several different individuals of various backgrounds, was created to look at certain issues and

make recommendations; issues such as, improved accessibility to mental health treatment,

alleviation of financial barriers. They will then present that report and any recommendations

before legislation in 2025. Although this workgroup and their research is definitely useful, as any

literature on these issues will tell you when they conclude that the most needed progression is

more research, further research will not solve the need for money to fund actual programs and

the drive and accountability to make them effective.

H.B. 0248, titled “Mental Health Support Program for First Responders”, adds a $1

million dollar grant for different agencies throughout the state to request aid for growing

assessment programs, peer support programs, or treatment programs. This may actually prove

highly beneficial, however the standards for who and how money can be requested still appears
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to be fuzzy. As many first responder organizations in small Utah towns are volunteer-based, and

the number of first responder units in Utah is large overall, this budget seems miniscule in the

shadow of the massive beast that is mental health issues in this population. However, this is a

step in the right direction regarding actual policies being implaced to make a difference.

Although the state’s hand’s are somewhat tied in regards to how much they can regulate inside

these varied organizations, the overall environment can be gradually shifted in regards to

encouraging organizations to utilize their county/city budgets in favor of mental health care.

Potential Solutions:

The goal for Utah should be first an emphasis on localized, more-individual research

conducted within specific organizations and units to determine what would be the most helpful

state input. Then, a multi-year program to offer access to enough financial support to get each

organization growing towards assessment programs, peer support programs, or treatment

programs. Once these programs have begun, then ensuring organizations have access to enough

education and training to ensure the environment encourages participation, and eventually the

ability to sustain such programs on their own without further state grants.

One local organization that has taken the initiative to ensure their employees are taking

responsibility for their mental health is the West Valley Police Department; they have utilized

the Blue H.E.L.P. organization, whose aim is to reduce the stigma that surrounds mental health

in law enforcement, where only 37% have said they have reached out to a therapist. In an attempt

to change this, the West Valley Police Department has an in-house therapist and officers are

required to attend 2-4 sessions a year depending on their position (Moser, Wilcox & Davis,

2020).
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The article, “First Responders: Mental Health Consequences of Natural and

Human-Made Disasters for Public Health and Public Safety Workers” outlines “evidence-based

psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions

and psychiatric disorders” such as psychological first aid, which is “the establishment of a sense

of safety (e.g., through evacuation or protection from re traumatization)”. Other components of

psychological first aid include “facilitation of social connectedness, fostering optimism,

decreasing arousal, and restoring a sense of self-efficacy through psychoeducation, basic

relaxation training, and cognitive reframing”. “Police, firefighters, and heavy equipment

operators, all represent public health workforces that may establish indi- vidual headquarters or

operations center sites within a larger disaster response environment” (Benedek, Fullerton, &

Ursano, 2007).

“The U.S. Departments of Defense and Veterans Affairs and the American Psychiatric

Association have developed and published practice guidelines for the treatment of depression

and also for the treatment of ASD and PTSD”. Other solutions include “public education, which

is an important part of population-based interventions to provide knowledge, reassurance, and

guidance to foster helpful self-care. In addition, leadership exercising good risk communication

skills (e.g., saying what is currently known, what is not yet known, and when new information

will be available) can greatly aid community cohesion and constructive actions. Public health

interventions can both limit distress and alter health risk behaviors (e.g., increased smoking and

alcohol consumption). In this way, such information and education can restore communities,

families, and workplaces and reduce the post disaster mental health burden of distress and

possible illness” (Benedek, Fullerton, & Ursano, 2007).

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“Natural and human-made tragedies (e.g., war) have demonstrated the extent to which

our national infrastructure can be threatened, damaged, or destroyed by disasters. These events

have emphasized the important role of our public health and public safety first

responders—including uniformed services, military and public health, and state, local, and

volunteer first responders—in protecting our nation’s citizenry in the aftermath of disaster.

Protecting our nation's health is a vital part of preserving national security and the continuity of

critical national functions” (Benedek, Fullerton, & Ursano, 2007).

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References:

Allen, J. A., Taylor, J., Murray, R. M., Kilcullen, M., Cushenbery, L., Gevers, J., . . . Fosler, K.

(2019). Mitigating violence against first responder teams: Results and ideas from the

hackmanathon. ​Small Group Research,​ ​51(​ 3), 375-401. doi:10.1177/1046496419876342

Benedek, D. M., Fullerton, C., & Ursano, R. J. (2007, April 21). First responders: Mental health

consequences of natural and human-made disasters for public health and public safety

workers. Retrieved February 24, 2021, from

https://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.28.021406.144037

GERRISH, C. (2020, March 11). More first responders dying by suicide than in line of duty.

Retrieved February 24, 2021, from

https://spectrumnews1.com/wi/madison/news/2020/03/02/more-first-responders-dying-by

-suicide-than-in-line-of-duty-

Imlay, A. (2021, February 09). Utah legislator SEEKS $1M in mental health help for stressed

first responders. Retrieved February 23, 2021, from

https://www.ksl.com/article/50103748/utah-legislator-seeks-1m-in-mental-health-help-fo

r
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-stressed-first-responders

Jones, S., Agud, K., & McSweeney, J. (2019). Barriers and facilitators to seeking mental health

care among first responders: “removing the darkness”. ​Journal of the American

Psychiatric Nurses Association,​ ​26(​ 1), 43-54. doi:10.1177/1078390319871997

Lawn, S., Roberts, L., Willis, E., Couzner, L., Mohammadi, L., & Goble, E. (2020). The effects

of emergency medical service work on the psychological, physical, and social well-being

of ambulance personnel: A systematic review of qualitative research. ​BMC Psychiatry,

20​(1). doi:10.1186/s12888-020-02752-4

SAMHSA. (2018, May). First Responders: Behavioral Health Concerns, Emergency Response,

and Trauma. Retrieved February 24, 2021, from

https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstrespon

ders-may2018.pdf

Stanley, I. H., Hom, M. A., & Joiner, T. E. (2016). A systematic review of suicidal thoughts and

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Kyron, M. J., Rees, C. S., Lawrence, D., Carleton, R. N., & McEvoy, P. M. (2021). Prospective

risk and protective factors for psychopathology and wellbeing in civilian emergency
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services personnel: A systematic review. ​Journal of Affective Disorders,​ ​281,​ 517–532.

https://doi.org/10.1016/j.jad.2020.12.021

Moser, A., Wilcox, K., Davis, A. (2020). The Quiet Crisis: Utah law enforcement share their

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https://www.ksl.com/article/50047463/the-quiet-crisis-utah-law-enforcement-share-their-

mental-health-struggles

Benedek, D., Fullerton, C., Ursano, R. (2007). ​First Responders: Mental Health Consequences of

Natural and Human-Made Disasters for Public Health and Public Safety Workers. ​The

Annual Review of Public Health.​