First Responders are at highest risk for mental illness and substance abuse: why many don’t seek help and what we can do.

In an effort to better understand the risk for first responders (police, medics, firefighters, military) one must first understand the foundation of risk prevention.

There are three methods of prevention: primary, secondary and tertiary.

Primary preventions are the type of interventions that aim to prevent any risk of injury, illness, or disease before they’re at risk. One of the most commonly used examples of  primary prevention is vaccinations. Another example is the D.A.R.E program (Drug Abuse Resistance Education) which would target our youth before exposure (commonly in elementary schools) as a primary drug prevention program.

Secondary preventions are the type of preventions that aim to reduce the harm of illness or injury that an individual has already been exposed to and/or at an elevated risk. Some common examples of secondary preventions are: 1) ensuring someone who is pre-diabetic changes their diet and exercises regularly to reduce the risk of becoming diabetic, and 2) juveniles who, based on their encounters with law enforcement and/or behavioral deficits at school, are placed in a mentorship program or group support setting to reduce any further risk of engaging down a criminal or maladaptive path.

Tertiary preventions are those that aim to decrease the intensity of existing illness or injury allowing it to be more manageable. Examples of tertiary preventions are various rehabilitation programs (such as physical therapy for those with disabilities or learning how to walk/talk again after a stroke), and chronic care management.


This post will focus primarily on mental health preventions rather than medical. First responders such as peace officers, EMTs/Paramedics and Firefighters, are exposed to traumatic experiences daily. They are the first responders to gruesome accident scenes, homicides, and tragedies. Imagine coming home from work regularly covered in unknown bodily fluids and images of an infant or child you tried to save but were unsuccessful? Or you get home and can still hear the sound of a bullet flying past your ear and narrowly missing you while you attempt to stop a robbery in progress? Daily experiences like those, over time, can cause some significant impact on an individual.

Any possible primary prevention options are lost the minute they begin working in the field. Unless they decline to become a first responder, there is no other true primary prevention available. What is available, and most ideal, are Secondary Preventions. Remember that secondary preventions are meant to reduce the harm of those already at risk of illness or injury.

First responders are at an elevated risk of developing acute stress reactions, post-traumatic stress disorder, depression and substance abuse due to their daily exposure to traumatic events. Not only are they the first witnesses to gruesome scenes, their lives are consistently on the line in ways we don’t commonly think of. Peace officers are fighting crime, and in doing so, are targeted by the offenders they’re attempting to restrain. Paramedics and EMTs are racing through traffic hoping that people pull to the right and are aware of their presence so as not to cause an accident in addition to ensuring life sustaining treatment for the patient in the back. And firefighters? Can we take a minute to revel in their bravery for entering burning buildings without any idea what the state of the fire is, the condition of the interior, or the LAYOUT of the interior, all in an effort to save our lives and homes?

That being said, Peace Officers in particular, have been the focus of a lot of negative media attention. In many of the incidents covered by media, at least that I have seen, it appears that the officer is being more reactive than is typically normal in those particular cases. From a strictly mental health perspective, these officers appear to have been exposed to many acutely stressful on-the-job incidents and their brain activates their sympathetic nervous system without a chance to properly assess first. In other words, their brains are perceiving every call as life threatening based on prior life threatening experiences.

People with acute stress reactions or post-traumatic stress disorder are at an elevated risk to abuse drugs and alcohol as a means of self-medicating the overwhelming symptoms of these conditions.

So why are we seeing so many Peace officers in the news who obviously are experiencing stress reactions from regular on the job trauma exposure?

Because they often DON’T GET HELP. Secondary prevention options are offered to first responders. There are staff psychologists for law enforcement, fire department, and other civil servant arenas. They are made available to use at any time by staff- but they routinely choose not to. Why?

After working in a criminal justice or law enforcement field for nearly 10 years, I have come to understand that there are several reasons as to why a first responder might not utilize the resources available to them.

  1. First, and most prevalent, they are afraid that they will lose their jobs or be placed on suspension. To them this means loss of pay, possible loss of their ability to carry a weapon, and, in they event they are fired, they have fears of what else they will do to make a comparable living with only obtaining a HS Diploma, Associates or Bachelors Degree with no other real viable work history.
  2. First responders often use humor and clowning around as a means of coping with the traumatic experiences they endure while on the job. If it is discovered they are regularly meeting with the staff psychologist, they are afraid that they will become targeted by their peers for doing so. It’s largely emasculating in many male dominant fields to seek mental health treatment yet it’s MORE acceptable to drink heavily.
  3. First responders work as a team. They have partners that they depend on in life threatening situations. It is extremely important for individuals in these positions to maintain their trust in their partner so they feel confident they will go home at night and put their children to bed. If it’s discovered that they are seeking mental health treatment, what will their partner think? Will they be concerned about their ability to maintain a clear mind during a risky situation? Will they ensure the safety of themselves and their partner and not flee or freeze? This could create another stressor for them that adds to the compounding stress they’ve already been experiencing.
  4. When your sympathetic nervous system, the part of the brain that activates the “fight or flight” process, is constantly switched “on” over extended periods of time it can be difficult to shut it off without professional help. Therefore many first responders use substances like alcohol, cannabis, and prescription opioids to alleviate the acute stress reactions they have due to high amounts of cortisol flowing through the body on a regular basis (side note: this can also lead to heart conditions, diabetes, and more).

So what can we do to help mitigate the risk of developing PTSD or substance abuse/dependence for our men and women in these positions if they aren’t using the resources available to them on the job?

I personally believe that many want the help, but they aren’t willing to initiate the first step in getting it due to the above-mentioned fears. Seeing the staff psychologist threatens the idea of confidentiality (i.e. they can be seen going in and out of the office, or their supervisors can see they’re using the services, etc) and this elevates their fear that they will be suspended from duty, lose their ability to carry a weapon, or be referred for a fitness for duty evaluation based solely on their desire to start seeking treatment.

The answer, I feel, is to find a licensed therapist or psychologist that works outside the organization and begin to learn about these conditions, learn how to train/retrain your brain to interpret situations appropriately, work on relapse prevention, and improve relationships at home which ultimately suffer the most.

I am able and willing to provide these services to our first responders via telepsych (through video chat) for a discounted rate. These services will be done outside of your respective departments, on your own time in your own chosen private location, and will exponentially reduce any fears that your peers will discover you are undergoing treatment. The goal is to use this as a secondary intervention and reduce the risk of developing a serious substance abuse habit and/or mental health condition. Please feel free to reach out to me on this blog to set up an appointment. Payment will be done through PayPal to ensure even more protection of your confidentiality. I am confident I can help to instill the hope and relief you need.

first responders

Be safe, be healthy, and be happy! You deserve it.


Dr. Engels

2 thoughts on “First Responders are at highest risk for mental illness and substance abuse: why many don’t seek help and what we can do.

  1. Dear Dr. Engels,

    I enjoyed the article very much and as a volunteer fire fighter I see this way too often. Many people think that opening up means that you are being weak and ‘can’t handle the job’ when we are exposed to a lot in the job.

    There are many great points. Excellent article!


    J. Watrel, Volunteer Fire Fighter HHFD


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