Tackling Mental Health Challenges in the Public Safety Sector: Implementing and Evaluating Mental Health Programs

Public safety sector workers including firefighters (structural and wildland), law enforcement officers, emergency medical services (EMS) clinicians, and corrections personnel are at a high risk of occupational exposure to traumatic events and stress. As such, mental health programs are critical for addressing the unique challenges these workers face. Effective programs must be multi-faceted, address organizational factors, and focus on building resilience, stress management, post-traumatic stress disorder awareness, and coping strategies. Such programs are critical for recognizing and addressing how the physical and psychosocial work environment and the organization of work can protect workers’ health.

The National Occupational Research Agenda (NORA) Public Safety Sector Council highlighted the importance of mental health programs in its 2019 National Occupational Research Agenda for Public Safety. Objective 6 notes the importance of considering the design of work, management practices, and the work environment in which workers operate to protect and advance worker safety, health, and well-being.

Because mental health issues among public safety workers is a growing concern, the NORA Public Safety Sector Council held a meeting with experts across the public safety sector to discuss efforts to evaluate the effectiveness of existing mental health programs in February 2024. This meeting furthered the Council’s conversation on mental health and prevention efforts. During the meeting, presenters described existing approaches to addressing mental health in the public safety sector. A summary of key messages from the meeting follows.

What mental health challenges exist in the public safety sector?

Presenters highlighted the unique challenges and work environments that organizations need to consider when developing mental health programs for public safety workers. For example, public safety sector workers often work long hours, encounter traumatic events, and have to make high-stress decisions. During the on-boarding process, public safety workers may receive information about Employee Assistance Programs (EAPs) and mental health care but integrated and sustained mental health programs may be limited. Furthermore, stigma may also affect workers desire to access programs when they are present.

Public safety workers face hazards that increase the risk for adverse mental health. For example, workers’ exposure to traumatic events can lead to mental health issues. Research has shown that fire and EMS personnel are more likely to die by suicide than from fatalities resulting from incident response.[1] Also, both law enforcement and corrections workers face a variety of workplace exposures related to violence. Numerous studies have indicated associations between workplace violence and mental health issues.[2]

Other examples unique to this sector are the many challenges facing wildland firefighters which present new and increasing risks to their health and well-being. These challenges include the seasonality of their work, an increased frequency and intensity of wildland fires as an effect of climate change and fuel conditions (i.e., dead leaves, grasses, etc. that can feed fires), an expanding wildland/urban interface, and workforce shortages. Finally, corrections settings typically expose workers to conditions of chronic conflict and stress. Research shows that corrections settings exacerbate physical and mental health disparities for corrections workers as well as incarcerated individuals.[3]

Workplace mental health programs in the public safety sector

Traditionally, public safety workplaces have used interventions that require active, ongoing engagement by workers. However, these interventions may not address the root cause in the work environment. In recent years, there has been movement towards more holistic interventions that engage multiple levels in an organization rather than relying heavily on individual workers. During the Council meeting, presenters discussed various interventions that have been or plan to be implemented in the public safety sector to help address the mental health challenges public safety workers face.

In the fire service, post-traumatic stress can put firefighters more at risk for suicide and impact various aspects of their daily lives, including their relationships with family members and colleagues. Managing occupational exposure to post-traumatic stress is an essential responsibility of the fire departments. One approach departments can use to manage workers’ exposures is to implement a trauma risk management system following a model that identifies resilient, acute, delayed, or chronic presentation trajectories (i.e., how symptoms present themselves over time). By monitoring and assessing workers’ symptoms, departments can better determine when to intervene and provide support.

In EMS organizations, the shared experience of occupational exposures among EMS clinicians has led organizations to focus on workplace peer support models to address mental health concerns. These models include mental health resilience officers, Battle Buddies, and the evidence-based Reciprocal Peer Support model. This allows EMS clinicians to support each other to enhance resilience and address the overall well-being of their coworkers.

Historically, law enforcement agencies have supported officers through services such as EAPs, peer support, and chaplaincy. However, agencies may not offer multiple services, so often only a single option is available or, if multiple are available, they may not be integrated effectively. In 2019, a statewide effort now known as the Responder Assistance Initiative and housed under North Carolina Emergency Management, took a unique step to unify these responder support systems to offer a holistic approach that leverages cross-agency partnerships to reduce stigma and meet multiple mental health needs of the workers.

Wildland firefighters have also been supported through services such as EAPs and peer support programs. However, their non-traditional work environment which typically involves temporary or seasonal work can impact their access to these services. There is a scarce amount of published data describing wildland firefighters’ mental health, so it is not well understood. Recent federal legislation has called for a joint Behavioral Health and Wellbeing Program between the Department of Interior and the U.S. Forest Service for all wildland firefighters that takes a more comprehensive approach to recognize and address their mental health needs. This includes year-round prevention training, care for post-traumatic stress disorder, and initiating an occupational culture that increases help-seeking and addresses stigma.

Corrections workers also face a unique work environment that is frequently associated with stress. In some corrections workplaces, employers have initiated programs aimed at teaching workers about the occupational hazard of “correctional stress.” These programs help workers recognize and express how their work may affect their health and their ability to maintain the judgment necessary to effectively perform their jobs. Trainings within these programs focus on building resilience and can include teaching about taking responsibility for decisions and behaviors; learning cognitive behavioral associations and strategies; practicing stress relieving techniques such as mediation and exercise; and learning when to seek professional help and offering supervision and support groups.

Evaluating mental health programs for effectiveness

To assess the effectiveness of a program, it must be evaluated. Throughout the meeting, presenters addressed the lack of evaluation studies on mental health programs among public safety workers. This gap may be due to difficulty in measuring changes in mental health; reliance on self-report of symptoms; logistical and ethical issues related to conducting experimental studies in the workplace; or difficulty getting agency, organizational, or worker participation for mental health studies. Currently, there are very few controlled studies among public safety workers.

However, one of the presenters described a partnership with the Responder Assistance Initiative (RAI) to understand how to expand the use of RAI services among public safety sector workers. This mixed methods evaluation assessed the reach, scope, and perceived value of RAI’s current services to generate data-driven next steps for RAI’s expansion. The evaluation identified recommendations for improving access to mental health resources within police agencies. These recommendations can be grouped into four categories:

1. Improving agency climate/culture to enhance the value of services;
2. Addressing concerns regarding the confidentiality of services;
3. Enhancing strategic outreach activities; and
4. Optimizing service access and utilization.

Key takeaways and next steps

Effective interventions tend to engage multiple levels in an organization rather than focusing only on the individual. Looking forward, the public safety sector needs more high-quality and longer duration studies with comprehensive and consistent reporting to help draw definitive conclusions on the overall effectiveness of mental health programs. Additionally, when evaluating programs, researchers should look beyond the use of services to determine effectiveness and assess whether the services led to a positive change.

Adapting to the technological, demographic, and socio-economic shifts in the evolving work landscape of public safety requires a transformative approach that expands the field of occupational safety and health (OSH) to include worker well-being. NIOSH’s Total Worker Health® perspective provides a potential framework the OSH community can use to address a broader spectrum of public safety workforce challenges. This holistic framework recognizes the importance of changing employment arrangements, chronic disease, and mental health conditions. Enhancing collaboration between OSH specialists and professionals from diverse fields can help reshape OSH research, workforce training, and policy design to maximize public safety worker health, safety, and well-being.[4]

Share your organizations’ efforts

We would love to hear from you. Does your organization have programs to support your mental health and well-being? Do you feel these programs are effective? In your opinion, how do you feel these programs could be improved to support employees in your workplace? To protect your privacy, we will not post last names or e-mail addresses.

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’.

Meghan Kiederer, BA, is a Health Communication Specialist in the NIOSH National Personal Protective Technology Laboratory and is the Communications Coordinator for the NORA Public Safety Sector Council and NIOSH Public Safety Sector Program.

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

Daniel R. Gerard, MS, RN, NRP, is the President of the International Association of Emergency Medical Services Chiefs.

Meret S. Hofer, PhD, is a Research Psychologist for the Workforce Wellbeing and Effectiveness Program at RTI International.

Kristen Wheldon, PsyD, is the President of the Fire Service Psychology Association.

Dana Neitlich, MSW, is the Senior Vice President of Human Resources at Centurion.

David Shapiro, BA, is the Senior Manager for the Center for Health, Work & Environment at the Colorado School of Public Health.

Wesley R. Attwood, Dr.CJ, is a Public Health Advisor in the NIOSH National Personal Protective Technology Laboratory and Public Safety Program.

Maryann D’Alessandro, PhD, is the NIOSH Public Safety Sector Manager and the Director of the National Personal Protective Technology Laboratory

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

References

1. Shaul Bar Nissim H, Dill J, Douglas R, Johnson O, Folino C. The Ruderman White Paper Update on Mental Health and Suicide of First Responders [online]. 2022. [cited 2024 Mar 22]. Available from URL: https://rudermanfoundation.org/white_papers/the-ruderman-white-paper-update-on-mental-health-and-suicide-of-first-responders/.
2. Rudkjoebing LA, Bungum AB, Flachs EM, Eller NH, Borritz M, Aust B, Rugulies R, Rod NH, Biering K, Bonde JP. Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis. Scand J Work Environ Health. 2020 Jul 1;46(4):339-349. doi: 10.5271/sjweh.3877.
3. Hayes L. Reducing inmate suicides through the mortality review process. In: Greifinger R, editor. Public health behind bars: From prisons to communities. Springer; 2007. p. 280-291.
4. Schulte P, Felknor S [2020]. An expanded focus for occupational safety and health. NIOSH Science Blog, August 19, https://blogs.cdc.gov/niosh-science-blog/2020/08/19/osh-expanded-focus/.