Suicides Among First Responders: A Call to Action

Posted on by Hope M. Tiesman, PhD; Katherine L. Elkins, MPH; Melissa Brown, DrPH; Suzanne Marsh, MPA; and Leslie M. Carson, MPH, MSW


The recent Surgeon General’s “Call to Action to Implement the National Strategy for Suicide Prevention” highlighted suicides as a significant public health problem. In 2019, there were 47,500 suicide fatalities in the U.S. and an estimated 1.4 million suicide attempts[1]. The causes of suicide are complex, with many personal, socio-demographic, medical, and economic factors playing a role. One potential risk factor is occupation and several occupations appear to be at higher risk for suicide, including first responders[2].

First responders, including law enforcement officers, firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, are crucial to ensuring public safety and health. First responders may be at elevated risk for suicide because of the environments in which they work, their culture, and stress, both occupational and personal. This stress can be acute (associated with a specific incident) or chronic (an accumulation of day-to-day stress). Occupational stress in first responders is associated with increased risk of mental health issues, including hopelessness, anxiety, depression, post-traumatic stress, as well as suicidal behaviors such as suicidal ideation (thinking about or planning suicide) and attempts[3]. Even during routine shifts, first responders can experience stress due to the uncertainty in each situation. During emergencies, disasters, pandemics, and other crises, stress among first responders can be magnified. Relationship problems have also been linked to a large proportion of suicides among the general population (42%)[4]. Because first responders can have challenging work schedules and extreme family-work demands, stress caused by relationship problems may also be magnified in this worker group.

Law enforcement officers and firefighters are more likely to die by suicide than in the line of duty[5]. Furthermore, EMS providers are 1.39 times more likely to die by suicide than the public [6]. Studies have found that between 17% and 24% of public safety telecommunicators have symptoms of post-traumatic stress disorder (PTSD) and 24% have symptoms of depression [7]. While telecommunicators are often the very first responders engaged with those on scene, research on their suicide risk and mental health has lagged.

Even given the high number of suicides, these deaths among first responders are likely underreported. There are insufficient data on suicides and mental health issues among these workers. Many first responders may consider stress to be ‘part of the job’ and feel that they cannot or should not talk about traumatic events and other occupational stressors. Perceived stigma around mental health problems or concerns over impact on employment (i.e. being labeled “unfit” for duty) may lead first responders to not report suicidal thoughts. Additionally, occupational data may be incomplete or difficult to capture for first responders, who often have multiple jobs and/or work in a volunteer capacity. More complete data are needed to identify risk and protective factors and to design evidence-based suicide prevention programs for first responders. In addition, prevention programs should reflect the differences among first responder groups and be tailored to each worker population.

What is Being Done to Prevent Suicides Among First Responders

There are several research activities to better understand and prevent suicides among first responders. As a first step, an inter-agency team of researchers from the National Highway Traffic Safety Administration (NHTSA), and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control (NCIPC) and the National Institute for Occupational Safety and Health (NIOSH) is analyzing suicides among first responders using the most recent three years of National Violent Death Reporting System (NVDRS) data available. The NVDRS is the only state-based surveillance system that collects data on all types of violent deaths – including homicides and suicides. This analysis will describe the circumstances of suicides among first responders. While current NVDRS data can provide a basic understanding of first responder suicides, there are many missing data elements still needed to complete our understanding of these suicides.

To address this gap in data, in 2020 the U.S. House and Senate approved funding for the Helping Emergency Responders Overcome (HERO) Act. This legislation directs the Centers for Disease Control and Prevention (CDC) to create a Public Safety Officer Suicide Reporting System to increase our knowledge of these events. The module will build upon elements collected as part of the current NVDRS infrastructure from the required source documents (death certificates, coroner/medical examiner reports, law enforcement reports) and will include information specific to the first responder community. These data will provide opportunities to better understand suicide fatalities and the circumstances around those fatalities among first responders.

Challenges and Successes

While enhancing data collection is an important step, we must recognize that many challenges are present for suicide prevention within these occupations. For example, there are few evidence-based interventions for first responders. Over the years there has been increased demand for interventions, yet most that are currently available have not been thoroughly evaluated. The military has conducted extensive resilience training and many first responder organizations are adapting this type of training for their populations, but without data, it is difficult to evaluate its impact.

Another challenge is the limited culturally competent mental health resources for first responder’s mental health needs. Often, first responders are sent to general mental health practitioners who may not understand the unique demands faced by first responders or the cultures in which they operate. While they may meet the needs of many clients, general practitioners may not understand what first responders experience on the job or be able to relate to them in a culturally competent manner. For many first responders, the transition from being a provider to client or patient is not an easy one. When a first responder finally seeks treatment, it can be devastating to encounter an ill-prepared provider and may result in reluctance to seek further help.

It is also important to highlight effective approaches to improving first responders’ mental health while noting that data on the effectiveness of these approaches with first responder groups is limited. One successful approach has been the use of peer-to-peer counseling and peer teams. Sometimes having peers who model healthy behaviors can assist in linking first responders in need of support to additional resources.

Another successful approach has been the use of formal and informal post event decompression sessions. These meetings are sometimes called a hot wash, debrief, or lessons learned. Building a routine practice to discuss what went well, how the response could have been improved, and any other issues after each call can also set the stage for these discussions to become routine and provide opportunities for responder decompression. While more casual meetings are not the same as more formal Critical Incident Stress Debriefings or post-event decompressions, any type of post-event debrief could help normalize discussions about mental health and suicide within first responder groups.

We would love to hear from you. If you are a first responder who has sought mental health services or been involved in developing interventions for suicide prevention, let us know in the comment section below what you thought was or was not helpful. Have you used peer-to-peer counseling? What would you recommend? To protect your privacy we will not post last names or e-mail addresses.

If you or someone you know needs support now, call or text 988 or chat 988 connects you with a trained crisis counselor who can help.


Hope M. Tiesman, PhD, is a research epidemiologist in the NIOSH Division of Safety Research.

Katherine L. Elkins, MPH, is an EMS/911 Specialist in the NHTSA Office of Emergency Medical Services.

Melissa Brown, DrPH, is a Behavioral Scientist in the NCIPC Division of Injury Prevention.

Suzanne Marsh, MPA, is a Team Lead in the NIOSH Division of Safety Research.

Leslie M. Carson, MPH, MSW, is a highway safety specialist in the NHTSA Office of Impaired Driving and Occupant Protection.



[1] Stone DM, Jones CM, Mack KA. Changes in Suicide Rates — United States, 2018–2019. MMWR Morb Mortal Wkly Rep 2021;70:261–268

[2] (SAMHSA. May 2018. Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma)

[3] SAMHSA. May 2018. Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma.)

[4] Petrosky E, Ertl A, Sheats KJ, Wilson R, Betz CJ, Blair JM. Surveillance for Violent Deaths — National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017. MMWR Surveill Summ 2020;69(No. SS-8):1–37



[7] Lilly, MM & Pierce, H. 2013. PTSD and depressive symptoms in 911 telecommunicators: the role of peritraumatic distress and world assumptions in predicting risk. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2):135-41)

Posted on by Hope M. Tiesman, PhD; Katherine L. Elkins, MPH; Melissa Brown, DrPH; Suzanne Marsh, MPA; and Leslie M. Carson, MPH, MSW

70 comments on “Suicides Among First Responders: A Call to Action”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Unfortunately this happens more often than people think. On April 1 of this year I was driving across the Pell bridge in Newport Rhode Island. I came across a vehicle with his hazards on in the right hand lane. As I passed by a gentleman get out of the passenger side of the vehicle stepped over the railing and jumped. And associate of mine Whose husband responded to the call that I placed 911 informed me that the gentleman was a police officer.

    “1.39 times more likely to die by suicide than the public” is that statistically significant? What is the comparison with similar cohort of say relatively young males? The risk in this kind of analysis is that it might actually induce suicides in susceptible individuals.

    The finding reported for EMTs was statistically significant even after adjusting for gender, age, race, and ethnicity (Mortality Odds Ratio =1.39; 95%CI=1.06-1.82). The comparison group for this study was non-EMTs in the state of Arizona. The study is included in the reference section and is only one such study showing an increase in suicides among first responders.

    It is a common myth that talking about suicide will encourage other suicides. There is stigma associated with suicide and many people are afraid to talk about it. Talking about suicide reduces this stigma and also allows individuals to seek help and share their story with others. See the WHO’s suicide myths doc and “Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?” for more information.

    Counseling Cops: what clinicians need to know (Guilford Press) is a resource to aid clinicians, chaplains and peer support staff become culturally competent. Written by experienced police psychologists , two of whom are retired cops.

    Thanks for posting this and helping to raise awareness! We at the Virginia Office of EMS have been proactively trying to address this issue. We completed an awareness campaign “Make the Call” in 2019 and also conducted a statewide survey on EMS provider mental health in 2020. We also have consolidated a bunch of resources about provider mental health and resiliency on our website. You can check out these resources at Feel free to reach out to us any time!

    Hello I would like to hear more about your make the call campaign. Sounds like something I would like to put together for my office.

    There are some interesting points in time in this article. There is some validity but I will take hold opinion until I look into it further. Good article, thanks and I want more! Added to my Feed as well.

    I am an MPH student at Rutgers studying the relationship between police officers firing a weapon on a call and suicidality. I have also found a gap in literature surrounding intervention analysis. Interesting point about firefighters and cops having higher risk of death by suicide than by occupation. I wonder if career and volunteer firefighters have the same risk?

    Thank you for your comment. Many of the data sources we rely on for suicide information don’t delineate career from volunteer firefighters. For example, the National Violent Death Registry System is based on death certificate data. The death certificate captures “usual” industry and occupation. The discussion section of this journal article provides a good description of the limitations of using a death certificate based system and the issues surrounding industry and occupation from this particular source.

    Volunteer Firefighters see and experience the same kind of calls as full time Firefighters, maybe not as often but only takes one that stays with you. I know this first hand.

    Thank you so much for the post you do. I like your post and all you share with us is up to date and quite informative, i would like to bookmark the page so i can come here again to read you, as you have done a wonderful job.

    After 25 years of fire and ems service I hit the brick wall. Though my employer had EAP contract. The counselor and sessions helped, she stated she had no idea what I do or experience. I had to educate her as she helped me. There needs to be more resources to help 1st responders become mental professionals.

    I’m a public safety psychologist and I hate hearing stories like that, where the counselor didn’t have a frame of reference for your world. I’m sorry that happened to you, and that it’s still happening to others. I think training first responders as clinicians is one good solution…the other is to teach clinicians about EMS culture (and fire, police, dispatch, etc.).

    Bryan Chapman, that was my experience too, and with a therapist who specializes in PTSD. During my interview, the therapist said she has had 1st responder patients. While not a total waste of time and money, we dealt with the comorbidity that goes along for the ride.

    I found an excellent therapist through our State Crisis Intervention Team. She focuses almost exclusively on first responders PTSD and chronic exposure to traumatic events as a medic / firefighter in a major metro department. Took some work to get there unfortunately and not everyone has the energy to dig deep for something that we all knew was out there.

    Bryan, thank you for your service and dedication to helping save others. As a pastor of many years I have found that the people who can help the most are the people who have themselves experienced those same situations in life.
    So, rather than cast off or stigmatize people as “damaged” or “not fit for duty” we need to recognize their struggles and help them help others, while they are also being helped in becoming healthy.

    Bryan, I really believe the Peer Support system used by Critical Incident Stress Management (CISM) is effective. It allows those going through stressful situations or trauma to be helped by peers who understand more of what a first responder may be going through.

    It is absolutely critical that those attempting to assist responders have at least a basic understanding of our jobs and the related lifestyle. I was discouraged from seeking further help because our EAP was so clearly ill equipped to deal with anything close to job-specific stressors and situations, that I had doubts that anyone would be able to help. I’m a believer in the concept of peer support even if we’re not trained in the psychology needed to provide true care. Having a listener that at least knows where one is coming from is probably worth far more than having someone with a psychology degree.

    Loosely related, why does EMS not receive more training in psychological emergencies? They have always been a big portion of our calls locally but they have mushroomed over the last year. As I’m fond of saying, it’s the call type we see the most of but have the least amount of training to handle.

    Thank you for your comment. You are correct that many EAP providers lack a complete understanding of the issues faced by first responders. This presents challenges for first responders. Some additional options for first responders include: which has resources for EMS as well as other first responders. Also, see: which has a filter for emergency responders when looking for a therapist in your area. There are many organizations working to better identify mental health professionals prepared to treat first responders.

    Regarding your question about training, the NHTSA office of EMS is working on addressing this in the current revision of the educational standards which will be released soon. Thank you for the suggestion.

    The Omaha Fire department has had 2 suicides in recent history. An effort has been made to establish PEER support groups and make contact numbers for mental health experts and peer support readily accessible at all stations. I developed sudden anxiety that I could not make sense of while at work. The hardest thing I had to do was ask for help and reach out to my Captain. This was in an environment where the job was actively encouraging members to seek help, and I still struggled to get up the nerve to ask. Long story short went to a therapist, got connected with a peer support group, and worked things out. If your struggling out there, please just call the number or talk to someone you trust. The old days of rub some dirt on it and suck it up are gone.

    Hello, my name is preston I am a former police officer. After getting out of law-enforcement I created an organization exactly as you mentioned above for peer to peer support. Our organization is going to be having seminars traveling from police departments, fire departments, and other first response facilities for the purpose of teaching pro activity about PTSD prevention. We are located in San Antonio Texas and we taking both first responders and combat veteran suffering from PTSD and effects of trauma. It is our hope that starting with Texas, critical incident stress debriefings will no longer be an option for the individual officer. This goes for all first responders. The average police officer does not know the damage he will be inflicting on his future self. Neglecting to take critical incident stressed he briefings out of a fear of being judged or just feeling macho has a greater sacrifice and they are realizing at the moment. Essentially they do not know what they don’t know. My organization will offer a consistent critical incident stress debriefing once a week after the incident to any department in need. We feel that the findings of the CDC hearing this article prove all the more that what we are doing is on the right track. Thank you for your research and putting out this article. However we are barely scratching the surface on where we could be in the future with this issue with the darkness, PTSD.

    Hello Preston,

    I appreciate and feel your frustration. I am so encouraged reading this article and also reading all of the responses…we are all on to something that we know is at a critical point. I believe that if we work together we can move mountains for our First Responders.

    I work with a Non-Profit company that is launching in January 2022. Our programs have been designed for first responders-by first responders; we promote wellness, intervention, detox, in-patient and outpatient programs that are Exclusively for First Responders in private locations exclusively among their peers.

    As I was building my network across the country, I was directed to an organization in Massachusetts that gave me hope that there are others who are in the exact situation that my son is in…a first responder, injured on the job, and lost most of his pension and all of his health insurance…and he has a wife and 3 children.

    I jumped right in to support this coalition with energy and elbow grease! Check out what Mario and Bob are working on in Massachusetts and New Hampshire (and every state soon thereafter). – Violently Injured Police Officers Organization.

    Thanks for listening, I guess you could say that my passion for saving our heroes gets the best of me.


    Thanks for important information! It’s true that first responders, including law enforcement officers, firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators are constantly exposed to stressful situations while working. They constantly need to make quick decisions that have consequences. The data on suicide among law enforcement officers, EMS and firefighters shoсked me. It is right to monitor the mental health of employees and prevent possible suicide attempts. There are different therapies and ways to monitor employee mental health improvement.

    Thank you for your comment.

    I am a graduate student studying PTSD and first responders. My field is strategic communications. I believe communication is a powerful change agent in these issues. I don’t mean communications alone but paired with the psychologist’s input. I am looking at communications beyond those impacted directly by PTSD but also include public administrators, HR, and policymakers who might inadvertently add difficulties or barriers in help-seeking faced by first responders.
    I mean why would a first responder want to speak up to management and HR if they fear their career chances will be wrecked by coming forward about having mental health issues?
    Do psychologists team up with strategic communicators? If so, that’s what I want to do.

    Thank you for your comment highlighting the importance of agency policy, communication, and culture. We agree that communication is a powerful change agent and are happy to hear that you are interested in pairing your work as a strategic communicator within the field of mental health and psychology. It is important to craft the right message and make sure that all those involved in the first responder community are aware of how department policies, resources and communications impact the health and well-being of the workforce. The first responder community still struggles with stigma, fear of being deemed unfit for duty and the discomfort of being the patient as opposed to the helper. It will take significant work on all fronts to improve how we communicate about mental health and mental health treatment, stress, resilience, and substance abuse and it would be wonderful if psychologists and strategic communicators were collaborating to help first responder organizations overcome these challenges. While we haven’t specifically looked for cases where strategic communicators and psychologists team up, we do recognize that a strategic communication specialist could assist in all facets of occupational medicine for a first responder agency.

    I am interested in if you have established any best proactices for strategic communications on this topic- I would be very interested in your work. Another piece of this large puzzle.

    I’ve had excellent success with my therapist/EMDR because they focus specifically on treating first responders and military folks. They are able to understand exactly where I am coming from without judgment, which I have in the past received from therapists who were poorly equipped to understand my life as a paramedic. It was indeed a fairly damaging experience for me to feel judged by a therapist who did not seem to understand the wide range of negative emotions that I felt when I was burning out and traumatized. It also helps that my therapist is very familiar with how toxic my former employer is due to how many clients they see who are former colleagues of mine: they are able to see the “big picture” of the politics there from many angles, which saves me a lot of time in session that I would ordinarily have to spend explaining a bunch of background information to any other therapist.

    Something that I would like to see studied further (in addition to everything else) is the prevalence of gaslighting, gate-keeping, and bullying in EMS departments. I ultimately left the ambulance after many years of service because I refused to put up with toxic departmental culture that only served to exacerbate my PTSD. I would very much love to share more information about my experience with you.

    Thank you for our article and resources for First Responders.

    I’m wondering if you have heard of Mental Health First Aid (MHFA)? I’m a part of a project that offers MHFA ( to First Responders and others. The one day training teaches laypersons how to screen and intervene when they see signs and symptoms of a mental health or substance use issues so people can get the help they need when they need it. The person trained in our program to provide first aid is not a counselor but is trained to offer information about local resources for appropriate professional and self-care help.

    MHFA is an international program that is on the SAMHSA’s list of evidence-based programs and has specific modules for EMS/Firefighters and Public Safety. MHFA is all across the country. Once we expand to Ohio and Kentucky we will be looking for FRs to teach our classes since they understand the unique culture. Thinking of the gentleman’s comment that more FRs should become mental health professionals, becoming a MHFA Instructor ( ) may be an opportunity for FR looking to play a bigger role in helping their peers with mental health issues. If a whole department/force was trained in MHFA, evidence shows that the stigma decreases as people feel more open to talk about it.

    Re: MHFA – can you point me to any peer review articles or data/evidence re: efficacy? I’ve looked but had no luck. Thanks in advance.

    Re: peer support teams: we’ve found resistance to providers engaging with their own agency’s peer support team. What has worked well is having another agency’s peer support team work with providers from our agency when appropriate. It helps reduce the stigma associated with reaching out for help.

    Mike, that makes a lot of sense. Teams of people who have gone through similar experiences just not in the same circle of influence. Great way to take the fear of being talked about behind the back or stigmatized by peers.
    Keep up the good work!

    Utilizing peers as the initial point of contact/entry has, in my experience been the most effective and embraced method I’ve seen. I have served in both a CISM role as well as a peer supporter role with both agency run teams (law enforcement) as well as with outside organizations. In each, we simply acted as that trusted bridge between responders and clinicians.

    All works well when each stay in their lanes and there are culturally competent clinicians to refer to that have been pre-screened and vetted. The larger hurdle in recent years has been finding clinicians who take a responder’s insurance. Many now opt for their clients to self pay which obviously becomes a hurdle.

    There are a few examples of this type of structure [company names removed] that offer the responder in crisis the path of least resistance and highest assurance of confidentiality.

    Peer support teams have been found to be highly effective because as we know, isolation is a huge contributor to suicide. These peers work as bridges to culturally competent resources.

    I would be really careful citing information in the ruderman white paper, as a lot of it not at all based on factual data and limitations were skipped.

    Mentioning that suicides exceed lodds is problematic in itself because we know the Suicide rate in the untied states is high. It’s 14/100,000 for white males it’s 27/100,000. First responders are overwhelmingly white male. The lodd for all occupations is 3/100,000. All people in the United States are more likely to die by suicide than in the lodd. Furthermore, lodds for first responders is low. Before Covid it was 2.5 /100,000 for professional firefighters.

    Highlighting the problem is great, but making statements that make the problem seem worse is problematic. The article nailed discussion on the hot wash, let’s nail more discussions on protective factors.

    Thank you for this comment. We agree that there are challenges to collecting quality data on suicides among first responders and limitations of specific methods should be considered. We believe the unique occupational hazards faced by first responders put them at risk for many negative outcomes – not just death. Finding ways to improve their physical and mental safety while on the-job is important to them, their families, agencies, and communities. NIOSH will continue to research how to keep workers safe on the job, even when fatality rates are low.

    I wish to use an excerpt from this article for a book I am writing that concerns PTSD and suicide among First Responders. Is this ok?

    Thank you for your interest. Yes, feel free to quote from this blog post. We just ask that you properly attribute the information.

    In your article, you mention “peer to peer” counseling. I am trying to gather information on peer to peer programs and how they are implemented with EMS agencies. Can you point me in to where I can obtain this information?

    I was a first responder Paramedic for 30 plus years in some of the busiest City in Mass. I learned first hand in 2014 how PTSD can strike without a person even recognizing the symptoms, leading to suicidal ideations, or even self medicating.
    My journey through this nightmare showed me how little resources, support from employers and most of all the Dept.of Public Health/Office of emergency medical services there are, especially when things have made a turn for the worst in one mental health.
    As far as Counseling goes, the evidences is spot on, most therapist can’t even explain the difference between and EMT and a Paramedic (both first responders but difference skill levels). yet they’re suppose to know how we feel see the unthinkable.

    One of the biggest issue are for those who work for private EMS service, who are contracted to do the same 911 emergencies as municipal, most private service are entitled or don’t qualify for the same benefits offered to Municipal or Union departments, which brings it back to a money issue, During my ordeal, most of the places geared to first responder PTSD did take my health insurance, leaving me with additional stress of out of pocket expenditure.

    Since 2014 there has definitely been more talk about about this issue, but the needs to be more Action with the Talk.

    I am more than willing to share my entire experience through this continuing nightmare, with anyone who wants to make this issue a priority.

    I also found out the hard way with no one to talk to and no one who noticed I was spiraling down into the darkness. Thank God I found a way out. Bless you brother.

    Hello. I work as a Fire Captain and part of our Departments Behavioral Health Peer Support team. I also am part of FIRESCOPE’s Behavioral Health Subcommittee. Nationally, there is an ever increase of awareness and help out there for those first responders needed or seeking mental help, however what is lacking is statistics. Ones showing the increase in those seeking help and the amount of peer support teams call volumes that are increasing daily. The stigma is still there for those seeking help and with education and legislation making seeking help easier, the situation for those who ask is changing. We all need to continue to be open and honest with ourselves and coworkers and to help recognize if there is a need.

    Biggest need is for culturally competent clinicians and access to mental health resources (first responder peer teams, crisis response canine teams) nationally with financial support for those who need it.

    I know too well what suicide does to the family. I lost my best friend and husband of 31 years to suicide in 2017. This was after he admitted himself to a Level 1 trauma center with suicidal ideation. He told multiple mental health providers including a psychiatrist that he was a career fire fighter and thought he was dealing with PTSD. Unfortunately, he was placed in an IOP for substance use disorder (alcohol) and never assessed for trauma. Consequently, I am a widow and my children no longer have their dad. This has to end. We should be studying the long term effects of stress hormones on the brains of first responders and determine what “normal” should be in addition to providing culturally competent clinicians to address acute trauma before it becomes PTSD.

    So sorry to hear this prayers for you all. There are alot of us out here who work dilligently behind the scenes shining a light looking and searching for those in need of help. There are also those on the front lines doing the same. God Bless

    I am so sorry. I almost lost my husband in 2017. I’m so grateful for the services that were provided him which included two weeks in a trauma unit. We see what’s happening and all too often nothing or not enough is being done.

    Jen Anderson

    Very good article. As a Veteran and currently a Firefighter for 17 years I have spent alot of time over the past years researching and digging into mental health well being and the affects of Trauma and derivative stress. For the last four years I have been involved in crisis intervention and suicide BID(Battle In Distress) work. Basically trying to convince someone to not take their life, then getting them the help and resources they need. From this perspective I can say, with all due respect, that researching and studying suicide is good but what we need besides a lot of awareness is PREVENTION. Knowing and really studying the signs and symptoms. Reaching out to someone who may not be “themself.” It has to go much further and alot deeper into it to be able to make a huge impact. Thank you for what you do putting out the intel.

    Yes, I could NOT agree more!! We need to find pro-active measures to support our first responders BEFORE they get to the point of suicidal.
    Thank you!
    Jen Anderson

    I remember many years ago reading a book on suicide, sorry too many years ago to remember the title. What I do remember is the statement made that “Suicide was a permanent solution for a temporary problem.” Life for most people does continue after an unpleasant event (relationship break up, job loss, death of a loved one, etc). While things are never quite the same, life does become manageable.
    However, in the case of first responders, the continued residual build-up of all the on-the-job events take a toll on their mental, physical, emotional and spiritual compasses.
    They cannot just “go home” and forget what they have seen, heard and felt.
    One of my older church members served oversees in World War ll. He shard with me that he and his fellow soldiers had 30 days to decompress while talking to their fellow soldiers on the ships during their 30 day voyage home.
    This is why I think that peer-to-peer groups are so effective for first responders today.
    However, the real problem of getting them to realize that they need this help before it is to late still remains.

    “Suicides Among First Responders: A Call to Action”
    It looks as though my first response did not come through.

    This was a well written article and defined a number of real problems beside there not being much data-to-date.

    Clearly, suicide is a growing problem in our society especially with first responders who have to deal with the stress of uncertainty and death daily.

    Not easy to come home and “discuss” your daily emotions. I would think that most first responders would not want to “burden” their loved ones with the stuff they face.

    Without a path of unburdening, the stress just keeps building until it reaches crisis point.

    Add some failed marriages, past traumas or financial burdens to that and suicide starts looking like a “good” alternative.

    This is where peer-to-peer groups and caring concerned health professionals really need to be available to step alongside this hurting individual. Which is exactly were you and I come into the picture.

    As founder of Firefighter Behavioral Health Alliance (FBHA) I began tracking and validating these tragic events of fire, EMS and dispatcher suicides. To date we have lost 1,746 souls. If there is anything we can do to assist you in your research then please do not hesitate to contact me.
    Thank you.

    Hey Jeff! Thanks for everything you do! I’m currently writing a guidebook to improve resiliency and reduce the risk of mental illness and suicide. In my research online, I have found so many stats on suicide deaths in the first responder community. I’m currently trying to get more first responders to come forward and obtain resources or join our peer group. In your research, aside from the stigma of self reporting, what have you found is keeping more first responders from self-reporting?

    Good evening Jeff, this issue with mental wellness in first responders is becoming an epidemic. I’m a retired fire medic 32 years on the job and toward the end I was in a bad place, that’s when I knew it was time to retire but that came with a price. Long story short I’m recovering from the effects of the job. I’m currently along with a few others in the process of starting a non profit foundation for first responders and spreading the word that its ok to talk about and deal with mantel wellness. I was curious oh how your research is going?

    I’m the founder of Survive and Thrive, a peer support and advocacy group. The biggest challenge I have found is getting first responders and healthcare workers to the meetings. I have met with many who have admitted individually they are struggling with depression, burnout, anxiety, etc. Many are still so fearful of the stigma surrounding mental illness that they can’t come forward in front of a group. Many have also expressed fear of being somehow punished for admitting they are suffering and their co-workers finding out or having it reported to their supervisors. What can groups like mine do to reduce this?

    I’ve worked as a private ems paredic for 15 years. I’ve used a critical incident debriefing once. I wasn’t able to go immediately after the incident. I ended up meeting with the appointed person two days after the call. I found it frustrating that we did not go over the call and the procedures performed. Ultimately ended with the person telling me I need more time for fishing. I’m a father of three young children. I am the provider for my family. I couldn’t begin to find the time for fishing. I have to put in all the hours I can. I know in my mind it’s not going to last this way. I wish there was something I could do. I related to the portion of this article that talked about feeling “disabled” or unable to return to duty. It terrifies me. I have to work. ?

    I am a first responder and am so thankful that the CDC is talking about this issue. I just found a therapist at a site that specifically has therapists for first responders. Its been really helpful to know I am not the only one going through these things.

    I have been an EMR/ Firefighter for over 6 years. My first really bad run was with a young man that was high and drinking while driving. He clipped the back of a truck and his car went airborne and rolled down an embankment. He was not wearing a seatbelt and needless to say he was bounced all over the inside of the car. I had to climb into the car to help get his body moved out. As I went to place my hands under his head there was no top half of his skull and lots of bleeding and then I realize his brain wasn’t there.his haunted me very much. Needless to say, I was curious and looked this young man up on social media…. #1 FIRST MISTAKE!! Never ever look up your patients when it’s been a traumatic death. This bothered me for over a month until I finally spoke to my Chief. I was ashamed to speak out but was so glad I finally talked. We are humans first and foremost. We have feelings we care about. But don’t forget you didn’t cause the scene you are there to help. There is no shame in speaking about your feelings. You have your team, your partner and co-workers, and in many cases a chaplain. Utilize them and their expertise in helping guide you through things. NOBODY is above council!! Seek help. There are so many places that can help. There are lots of online as well as community resources. Too many have taken their lives because of ” pride” in their job or positions as an EMR/EMT/Medic. Nobody is above speaking out and saying ” hey this particular case has gotten to me.

    Having served as a FMF Corpsman, USMC in Vietnam, I naturally gravitated to the Fire Dept. Paramedic program. We had to see and deal with a lot of human misery and death. After 10 years as a medic, I was through. It was time to get out. I promoted to Lt. on an Engine Co. and then to a Captain on a Truck Co. One thing that was not mentioned was a person’s “spiritual life.” “The eyes are the pathway to the soul.” First responders see and experience more than most civilians will ever know. I had the tremendous benefit of being raised a traditional Roman Catholic, attending only the traditional Latin Mass. To true Catholics, suicide is a mortal sin. It is not an option. I never considered taking the route of Judas Iscariot. Many of my co-workers and friends decided to end it all for various reasons. It crushes you when you learn about them. If you put the condition of a person’s soul off limits, don’t expect to ever make a dent in the suicide statistics of cops, firemen and EMS personnel. The secularist’s options are not enough and never will be. It’s the condition of the human soul that is at the root of this problem.

    At the end of the article, it states texting 988 or chatting online at, the person would be connected with trained crisis counselor; would this counselor likely be trained specifically for first responders or general population?

    Thank you,
    Billy G

    I had an SA October 2021 on shift as an EMT and Medical Assistant, (I was working both jobs) and was told to resign after 3 months of medical leave. It was later found out that I have bipolar one disorder now. HR never confronted me about this.

    Thank you for your comment. We hope you are doing well and have been able to obtain the appropriate medical treatment. NIOSH has a Health Worker Mental Health Initiative and a website on Suicide and Occupation which provide links to work-related resources. As society becomes more informed about mental health issues we hope that issues surrounding mental health in the workplace evolve.

    I am the wife and mother of law enforcement officers. As such, I provide holistic mental wellness training for first responders locally that focuses on burnout and suicide prevention. I also provide training in peer support techniques. I am hoping to expand my program to offer it on a larger national scale and would be interested in possibly partnering with researchers to test its effectiveness. Prevention for first responders must be approached from a whole health perspective and address things like inflammation, nutrition, and sleep disruption.

    I’ve been in public safety for most of my adult life (I’m middle-aged now). I’m also transgender and have been rejected by my immediate family and many of my colleagues; I am medically retired as a paramedic due to PTSD. Back in February I called for help at the last moment before I shot myself and a crisis line sent the police. The police have now charged me with a crime for having a firearm outside my home without a permit. I have never so much as been accused of a crime, I never discharged my weapon, and never would have harmed another soul, but they’ve now done something that will end my career and destroy my life. I am being punished by my own profession for reaching out for help and I will never reach out again for any reason.

    Thank you for this excellent blog post and thank you to the commenters for sharing their experiences and, to many, for your service. I’ve been involved in a universal, population-based screening effort that uses the electronic version of the Columbia Suicide Severity Rating Scale, among the best if not the best screener for suicide risk. We screen in middle and high schools. The advantage of electronic data capture directly from students is that they disclose more about suicide risk factors to the computer than to a clinician. This could be particularly relevant in the first responder culture described in this post. In every screening we do, we find at least one young person who isn’t on the radar at the school or with their parents as being at risk of suicide. We also work with a wonderful non-profit that provides same-day care to those screening positive for recent suicidal thinking or behaviors. Our partner organization also creates continuity of care either through a referral to the student’s doctor or, in the many cases where students don’t have access to care, through evidence-based case-management with a therapist. I wonder if this “Screening Linked to Care” model, possibly including a role for peer support, and leveraging clinical resources provided through a health plan or an EAP could be adapted to help the first responder community. There is clearly a growing need.

    I was a State Trooper for 5 years and have been a Federal LEO for 10. I recently started battling depression, having nightmares, and flashbacks. I called several places to be told there is a mental health crisis and the earliest I could be seen was a month or more. My mom is a nurse and said if I voluntarily signed myself in to a mental health facility I would be seen by a psychiatrist immediately. (By this time I was having suicidal thoughts) I went to the hospital on a Tuesday night, saw the psychiatrist Wed, and left Thur morning. I was prescribed two anti depressants which I was told would not affect my job performance and one helps with focus. On my release form it stated I was diagnosed with unspecified depression, and it also had suicidal checked on the form. I had taken annual leave and will be off for another week but did not state why. I fear I have ruined my career and will probably have my firearms taken away and ultimately terminated. I have not been able to sleep because of the stress of being unemployed soon and my co workers finding out along with my boss who I respect very much. I have worked so hard and sacrificed so much and feel I threw it all away because I was fighting demons and just didn’t know where to turn.

    If you are experiencing thoughts of suicide or in emotional distress, please reach out to the 988 Suicide and Crisis Lifeline where counselors are available 24 hours/7 days a week. When you’re in crisis, research suggests that it may be helpful to reach out to others. And we understand that in some areas, waits to see mental health counselors are long. The 988 Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress. You can either call or text ‘988’.

    Other resources specific to law enforcement include Blue Help ( and in the State of Virginia, the Virginia Law Enforcement Assistance Program or VALEAP (| Helping Virginia Law Enforcement since 2008 (

    Please know that it won’t stay this way. It won’t always feel this way. It will get better. After I lost my husband I battled for months. It felt like it would never be anything but pain. It didn’t stay that way. Widow of Master Deputy (name removed) in Charleston, SC.

    *Some text removed per NIOSH Science Blog comment policy

    I do not take our officers, veterans, or EMS for granted.

    Prayers to families and co-workers in the days and years to come. You are not forgotten.

    From a family member of veterans, VA worker, former jailer dispatcher, mental health nurse, and a person who knows what it feels like your brain being hi-jacked with suicidal thoughts.


    Love Patti O.

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Page last reviewed: July 18, 2022
Page last updated: July 18, 2022