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Before the Fall: Support First Responders with Mental Health Crises
Thomas A. Bezruki CD.
ESMS-4900: Capstone
Justice Institute of British Columbia
Professor Beth Larcombe
April 5, 2022
Advisor: Darcye Lovsin

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Abstract

Background: First responders (FRs) face a variety of hazards and trauma on any given day.
Regular exposure to these traumatic events such as fatal accidents, burn victims, drug
overdoses, suicides, murder etc. can take a toll on an individual’s well-being and mental
health (MH).
Aims: The aim of this literature review is to examine recent, empirical studies to determine
adequacy of MH resources available for contemporary FRs.
Methods: Empirical literature search included Justice Institute of British Columbia Library
database, Google Scholar and two non-scholarly website sources.
Results: Several linear themes that emerged in relation to the research question. These themes
include proactive mental health initiatives, trauma-informed perspectives, de-stigmatization, peer
support, and barriers to access resources.
Conclusions: Considering the complexity of trauma-related MH issues facing FRs, further
research is warranted. FRs, as well as mental health care providers require more thorough
understanding of the issues in order to provide better assistance for mental health.
Key words:
First responders, mental health, prevention, resilience, resources, peer support.

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Table of Contents

Abstract ........................................................................................................................................... 2
Table of Contents ........................................................................................................................... 3
Background ............................................................................................................................... 4
Objective .................................................................................................................................... 4
Defining Research Question ..................................................................................................... 4
Problem .................................................................................................................................. 5
Interventions .......................................................................................................................... 5
Comparisons .......................................................................................................................... 6
Outcomes ............................................................................................................................... 6
Selection ..................................................................................................................................... 7
Inclusion and Exclusion Criteria ............................................................................................. 7
Results ........................................................................................................................................ 8
Literature Review ........................................................................................................................... 9
Critical Analysis ........................................................................................................................... 17
Barriers .................................................................................................................................... 17
Stigmas ................................................................................................................................. 17
Gaps ...................................................................................................................................... 18
Training/Education Programs ............................................................................................ 18
Exercise ................................................................................................................................ 19
Discussion..................................................................................................................................... 20
Recommendations and Direction for Future Research.............................................................. 21
Conclusion.................................................................................................................................... 22
References .................................................................................................................................... 24

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Before the Fall: Support First Responders
with Mental Health Crises

Background
First responders (FRs) face a variety of hazards and trauma regularly as part of their
occupations. A 2008 study of mental health (MH) and suicide showed that police officers and
firefighters are more likely to die from suicide than from a work-related incident (Heyman et
al., 2018). Increases in MH issues, post-traumatic stress disorder (PTSD) and rates of suicide
have prompted research into what FRs need to maintain good MH (Joyce et al., 2019).
Objective
The aim of this research study is to examine currently available information, data and
statistics to determine if there are adequate resources available for today’s FRs. It will
acknowledge the current crisis of MH issues affecting FRs and examine the readily available
resources for workers who want to reach-out. Utilizing data acquisition through sources such as
Justice Institute of British Columbia Library database and Google Scholar, this review attempts
to answer the following research question: Are sufficient and appropriate resources accessible to
support FRs dealing with MH crises?
Defining Research Question
The research suggested that there are potential gaps, barriers, accessibility issues and
stigmas related to MH issues for FRs (Heyman et al., 2018). The question behind this study is
to confirm whether or not existing programs and resources are sufficiently available to support
first responders and to identify the barriers that prohibit FR’s from accessing these programs
when they are experiencing MH crisis. This review uses mixed methods to 1. Identify the
problems surrounding MH for FRs, 2. Identify intervention methods and tools that are used and
accessible for FRs, 3. Compare the methods and tools available, and 4. Discuss the desired

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outcome of interest.
Problem
A recurrent gap and theme identified through research is an overall lack of funding and
research into appropriate initiatives and programs for FRs MH. A deeper in-depth discussion and
consideration of MH issues -specifically for FRs- is imperative to understand the correct
implementation of effective versus ineffective strategies to generate a meaningful and positive
change for this prevalent issue of MH.
Barriers noted in study findings (Heyman et al., 2018; Jones et al., 2019) are
contributing factors faced by FR’s experiencing MH issues in early stages, all the way to late and
chronic stages of symptoms. The studies reviewed present prevalent barriers: i.e., lack of easily
accessible resources, overall lack of education in the subject, fear of being a burden on family,
psychosocial culture creating negative stigmas, feelings of being alone in the struggle, negative
experiences coming from therapy, lack of buy-in from peers, administration, and workers’
unions/associations. Without addressing and attempting to resolve these barriers, little forward
progress will be made to improve help-seeking behaviours. Good section
Interventions
Mental healthcare is an extremely important component of personal well-being for FRs.
The data analyzed shows clear benefits of MH training, and education programs for staff and
management which would in-turn promote peer support initiatives. Other ways of intervening
backed by the studies are methods such as self-assessment tests (available online or internally)
through the FR agencies. While the research shows positive benefits from these methods of
intervention, findings show the need for more research and resources. This study attempts to

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highlight both effective means of intervention, as well as the need for further research and
accessibility of these interventions.
Comparisons
Considering there is no definitive way to eliminate barriers to an individual’s helpseeking behaviour and at what stage of crisis that they choose to seek help, a range of methods
and intervention tactics should be available and accessible. More research into the area of
methods and intervention would contribute to determining the levels effectiveness of MH
treatment. However, it is difficult to say one method or intervention tactic is unequivocally better
than another due to the individual nature of someone’s mental state. This study reviewed
examples and studies that highlight the effectiveness of various methods of assisting FRs who
are afflicted by MH from exposure to job-related trauma(s).
Outcomes
The desired outcome of this study is to highlight the importance of FRs mental
healthcare, both personally and professionally. A healthy FR workforce benefits the FR and their
family as well as the general public at large as they are more capable of meeting their mandate
for community safety and assistance. By revealing the prevalence of MH issues among FRs,
organizations can encourage crucial steps be taken in a forward direction through research and
positive change. Removing the psychosocial stigma associated with FRs who are seeking
assistance may help those currently in crisis, as well as those who may experience crisis in the
future. Implementation of comprehensive MH education and training for all levels of staff in FR
agencies would inherently improve peer support initiatives and could potentially minimize the
amount of MH cases reaching chronic or crisis stages.

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Research Methodology

Selection
The selection of studies was accomplished by first examining all titles and abstracts, then
reviewing the remaining content to identify key information that supports the research question.
Some of the main inclusion criteria were: studies conducted after 2010, peer-reviewed literature,
research-based on statistical data or surveys, subject matter that focused on FRs, prevention,
assessment, treatment, stigma(s), peer support, exercise, training, MH apps and resilience.
Studies were located utilizing key-words (First responders, mental health, prevention, resilience,
resources, peer support, Apps) in searches utilizing multiple electronic databases 1. Justice
Institute of British Columbia Library Database and 2. Google Scholar. Current and reliable,
empirical research, using accurate and current data, served as base materials used to answer the
research question (see Table 1).
Inclusion and Exclusion Criteria
Inclusion
Inclusion criteria included peer-reviewed literature published after 2010. Studies
focused on FRs: wildland firefighters, urban firefighters, career firefighters, volunteer
firefighters, emotional support workers, federal police, provincial police, municipal police,
paramedics and military personnel. Additionally, studies examined prevention assessment
and/or treatment, social stigmas, help-seeking behaviours, resilience, peer support
intervention, benefits of exercise, internal agency prevention programs/education/trainings
and MH apps. Sources searched include qualitative and/or quantitative methodology.
Exclusion

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Demographics such as age, gender, culture and religion are not part of this research
study. To ensure a narrow focus of information and reliable sources, this research study
excluded sources from popular magazines, newspapers, studies that are not specific to FRs,
non-English publications, opinion pieces, Covid-19 related studies and studies published
before 2010.

Table 1

Results

Result Search Methodology

Note: The table shows the research methodology process for study selection, including process of
elimination.

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Literature Review

In the following review, 17 studies and two websites were analyzed to define the research
problem and to contribute to discussion and future recommendations. A description of each study
was included, as well as quotes and statistics.
A study on the Road to Mental Readiness or R2MR program. Szeto et al. (2019) details
the creation of the R2MR program in 2013, the content of the R2MR program provided to FRs,
and a research study of significant data points on efficacy provided by participants of various FR
groups.
The R2MR program was designed to be used as part of a participant’s organizational
training with the expectation that “program completion would decrease mental illness stigma and
increase resiliency when compared with assessments conducted before the program” (Szeto et
al., 2019, p.20S). Data collection additionally included a follow up with participants three
months post R2MR program completion. Szeto et al. (2019) valuation of the program included
positive results indicating “that R2MR was effective at increasing participants’ perceptions of
resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly
maintained at the three-month follow-up” (p.21S). The data compiled with this study suggested
that the R2MR program “helped to shift workplace culture and increase support for others”
(p.21S). This study was of value due to the R2MR program's pre-emptive strategy towards harm
reduction and resiliency building, and the positive outcome provided in the studies results.
“Responding to First Responder Mental Health” is a research study prepared by Isabel
Ruediger (2021), for the University of Calgary, which examined current MH trends that focus on
proactive initiatives for FRs that support resilience and psychological readiness in response to
occupational exposures to trauma. Her research indicated that existing MH programs are largely

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reactive and could benefit from incorporating proactive indicators to best support the MH of
FRs. In her research study, Ruediger asserted that, “First responder mental health has
historically been addressed in a reactive manner rather than preventative once exacerbated
symptoms have set in, such as depression, acute stress, burnout, or PTSD” (Ruediger, 2021,
p.16). This paper supported the research question, that there is a need for more sufficient MH
resources for FRs.
The study “Supporting the Mental Health and Well-Being of First Responders from
Career to Retirement: A Scoping Review” (Smith et al., 2021) focused on identifying effective
strategies to support MH, both during and after the first responder's career. Rather than placing
the responsibility on the FRs to reach out, their findings suggest holistic approaches that
encourage organizations to “reach in” to FRs regarding mental health needs. This study was
valuable because it discussed proactive MH strategies, harm reduction, and the importance of
holistic MH approaches.
The Ruderman White Paper on “Mental Health and Suicide of First Responders” by
Heyman et al. (2018), addressed the importance of adopting strategies to help raise awareness on
the psychological tolls that incidents exert on FRs. This study demonstrated how dangerous it is
to ignore the MH crises among our FRs. Researchers interviewed emergency workers from
several different professions, including police officers, police communicators, paramedics, and
child protection workers. This study also sought to raise awareness of MH well-being among
FRs to alleviate stigma and facilitate access to services. According to Heyman et al. (2018), “It is
critical to address this issue in order to destigmatize mental illness so that our heroes are able and
comfortable to access the care that they need” (p. 9). The study suggested debunking cultural
barriers within professions and departments, eliminating perceptions of MH and enforcing

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adequately funded policies and programs would help in reducing the recent MH crisis amongst
FRs. The President of the International Association of Chiefs of Police (IACP) has said, “In a
profession where strength, bravery, and resilience are revered, mental health issues and the
threats of officer suicide are often ‘dirty little secrets’ – topics that very few want to address or
acknowledge” (International Association of Chiefs of Police [IACP], 2014, p. III).
Table 2 displays the staggering comparison of the prevalence of issues relating to alcohol
abuse, depression, thoughts of suicide and PTSD when numbers of the general population are
compared with FRs. These figures are based on the sample base from the Heyman et al. (2018)
study.
Table 2
Mental Health Outcomes

Note: This table displays the comparison of the prevalence of issues relating to alcohol abuse,
depression, thoughts of suicide and PTSD when numbers of the general population are compared
with FRs. From “The Ruderman White Paper on Mental Health and Suicide of First Responders”
by Heyman et al., (2018)
https://www.firefightermentalhealth.org/system/files/First%20Responder%20White%20Paper_Fi
nal.pdf. Copyright 2018 by Meriam Heyman et al.

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“Can Resilience be Measured and Used to Predict Mental Health Symptomatology
Among First Responders Exposed to Repeated Trauma?” was a study conducted by Joyce et al.
(2019) in order to determine if implementing resilience measures among FRs could help protect
their long-term MH. This study used a multivariate linear regression to examine the correlation
between baseline resiliency and future MH symptomatology following repeated trauma. The
baseline sample included 143 FRs from New South Wales, Australia (FRNSW).
According to Joyce et al., (2019), studies have shown that despite the regular mental risks
FRs encounter daily, they are very reluctant to access MH services. It states many FRs would
rather engage in harmful and maladaptive coping strategies to manage their mental distress. This
study identified “One benefit of examining resilience is that this construct is malleable, learnable
and responsive to change and can thus be targeted in early interventions” (Joyce, S. et al., 2019,
p.286). The findings further outlined that “Studies have indicated psychological resilience may
serve as a protective factor which may alleviate the negative impact of work-related stressors
among first responders.” (Joyce et al., 2019, p.286).
This study relates to the research question as it outlined the importance of resiliency
programs for FRs. It also confirmed its use in helping FRs with MH illness.
Table 3
Demographic Characteristics of Low and Average to High Resilience Groups at Baseline.

Note : (Joyce, S. et al, 2019, p. 287)

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The 10 item Connors- Davidson Resilience Scale; PTSD, post- traumatic stress disorder.
(as cited in Joyce, S. et al., 2019, p. 288)
Note: The relationship between baseline resilience levels and symptoms of PTSD depression and
alcohol misuse at 6-month follow-up.
In a US-based meta-analysis study, statistics showed that 33.1% of all FRs endorsed
stigma items such as fears regarding confidentiality, negative career impact, scheduling issues
and simply being unaware of how or where to seek assistance (Haugen et al., 2017). The Haugen
et al. (2017) research study concluded that there is an extreme lack of research in the area and
there is a need for further research to recognize and assist the issues. Self-stigma can show itself
as low self-esteem, feelings of insignificance, secrecy, embarrassment and retraction from social
interaction (Boyd et al., 2014). The perceived stigma felt by some individuals can create a barrier
that may prevent someone who has been exposed to traumatic event(s) from seeking help. These
symptoms need to be recognized by the afflicted individual or by peers so that the individual can
receive appropriate help.

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“A review of cardiorespiratory fitness-related neuroplasticity in the aging brain” was a
study by Hayes et al. (2013), that identified that resiliency as one of the most important
deterrents for FRs because of its focus on training mental strength through attention and
awareness. Developing strong resiliency can assist in preventing the impact that trauma can have
on an individual. This study also looked at the resiliency effects of exercise shows promising
data that can be of benefit to FRs. They found through their research that brain changes can be
exercise-induced stating that “researchers found overlap among the brain regions affected by
post-traumatic stress disorder (PTSD) and brain areas impacted by aerobic exercise. This
suggests that exercise-induced brain changes or neuroplasticity may positively impact PTSD
symptoms” (Hayes et al., 2013, p.10).
Firefighters experience varied exposure to unique traumatic events frequently, while
cases of PTSD are understandably not uncommon within this group. A nationwide study (2018)
in South Korea gathered data on PTSD and barriers to treatment among all currently employed
firefighters at the time (n = 39,562) (Kim et al., 2018).
Out of the sample group, 5.3% (n = 1,995) were found to harbor probable cases of PTSD
and among those affected, only 9.7% had sought out or received any type of help or support.
While perceptions regarding barriers to accessibility (23.9%) and concerns of potential stigma
(38.8%) were the reasons for not seeking treatment (Kim et al., 2018). The Korean study
highlighted the need for novel approaches in promoting mental healthcare for firefighter FRs. In
the discussion section, Kim et al., (2018) talks about firefighters’ fear of stigmatization and of
being ‘weak’ or ‘vulnerable’.
The Australian Journal of Psychology published a study by Rikkers et al., (2021) titled
“Mental health help-seeking experiences and services use among Australian first responders”.

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This study’s aim was to better understand and highlight patterns of FRs reaching out for help
regarding PTSD and psychological distress.
The authors utilized data received from The Australian National Survey of the MH and
wellbeing of police and emergency services’ initiative entitled Answering the Call. The study
was conducted between October 2017 and March 2018. Sample participants (n = 14,868) were
selected using stratified random sampling from 33 separate firefighter, police and state
emergency service agencies.
The results suggested that 3 out of 5 employees felt the need for MH assistance within the
previous 12 months, but less than half of those actually sought help. The study also stated,
“There were a concerning number of people exhibiting symptoms of serious mental health
conditions who recognized they had a problem, but who did not think they needed any help
(5.9% with severe PTSD; 27.9% with high and 18.5% with very high psychological distress; and
15.5% who experienced suicide ideation in the previous 12 months)” (Rikkers et al., 2021, p.31).
The study’s findings revealed less than optimal results in help-seeking behaviours among
FRs and indicates the possibility of poor psychosocial work environments for these employees.
This could mean that access to resources does not necessarily guarantee outcomes.
A study out of the Journal of the American Psychiatric Nurses Association conducted by
Jones et al., (2020), interviewed firefighters and medical technicians/paramedics from across the
State of Arkansas to gain a better understanding of barriers and facilitators to seeking mental
healthcare. Facilitators to Help-Seeking Behaviours (FHSB) are defined as programs, initiatives,
policies, organizations and include measures, interventions and workplace culture that serve to
assist and enable afflicted individuals (experiencing MH issues) to reach out for appropriate
assistance. Individual qualitative interviews took place in private settings that were most

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convenient for the participants. Analysis of the answers from the sample group (n = 32),
indicated 3 main factors which influenced help-seeking behaviours 1. General Knowledge of
available resources, 2. Barriers to help-seeking behaviours, and 3. FHSBs (Jones, S. et al., 2020).
Jones et al. (2020) findings presented unique perspectives that shed light on how FRs prefer to
address their MH needs and issues. Participant answers regarding the FHSBs seemed to have
common themes after analysis: 1. The feeling of not being alone was a theme that arose from
questioning. 2. Knowing that other FRs could be going through the same issues and 3. Seeing the
possibility of recovering the same way as others were motivating factors in seeking assistance.
Interestingly, ‘buy-in’ was a term used by 14 of the participants. Buy-in refers to having
acceptance and support from peers, administration and the labour union supporting mental
healthcare. For example, one participant answered: “Every safety thing comes down from
usually the national level or [International Associations of Fire Fighters] IAFF or whatever…
You take the IAFF, okay, our goal is to assist the mental health of our first responders,
firefighters, whatever. You see that push and you get that change in the mentality, I think that’s
when it changes” (Jones et al., 2020, p.49). Sadly, for some FRs they do not seek help until they
are at their lowest point and reaching out is the only viable option.
Figure 1
Perception of MH problems and engagement.

Note: Analysis of the interviews generated three broad factors that influenced FRs’ perception of
MH problems and engagement in MH services: (a) Knowledge, (b) Barriers to help-seeking, and
(c) Facilitators to help-seeking.

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(Jones, S. et al, 2020, p. 48)
This study suggested that FRs, as well as mental healthcare providers, required a more thorough
understanding of the deeper issues in order to provide better assistance for MH crises.
Critical Analysis
While the studies reviewed varied in technique and methods, there were common threads
identified which affected the recognition and treatment of MH issues. One of the most frequently
noted was the fact that due to the nature of the work performed, FRs are reluctant to ask for help
because of the perceived stigmas attached. Education and Training at all levels was also
identified as lacking. The training issue could be related to a gap in funding for these programs.
Barriers
Stigmas
The research considered for this review consistently portrayed stigma as a significant
barrier to help-seeking behaviour. The study by Heyman et al., (2018) stated that stigma and
shame are the strongest barriers between FRs and help-seeking behaviour. There are many
factors that contribute to stigma regarding MH for FRs, but the consistent theme is that the most
common feelings of stigma for FRs revolve around showing weakness or vulnerability by
seeking help.
The psychosocial culture among FR agencies seems to be the most significant contributor
to the feelings of stigma. The very traits and characteristics that are seen as making a good FR
such as perseverance, toughness, courage, selflessness and grit are, on the other hand, barriers to
FRs seeking the help they need at the right time. Help-seeking behaviour doesn’t seem to fit
within these strong traits. FRs are one of the few lines of work where individuals are
continuously exposed to traumatic incidents that can eventually take a heavy (even fatal) toll on

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MH and well-being. These jobs, where attitudes of mental toughness and fortitude are essential
to staying focused and effectively doing their jobs, are great strengths that potentially become
liabilities when seeking out MH solutions (Kim et al., 2018).
Stigma becomes especially insidious when individuals are at a chronic stage, where they
feel that help is necessary but refuse to ask for help - due to stigma. The stigma studies in this
review concluded that more research is decisively needed to understand and address the issues
surrounding the barrier of stigma. Some responses regarding FHSB are rich fodder for future
research in order to further develop initiatives that could create a positive shift in the number of
FRs who are experiencing MH issues and not exercising help-seeking behaviours.
Gaps
A recurrent gap identified in the studies reviewed was an overall lack of funding for, and
research into, a more in-depth discussion and consideration of first responders’ MH. Additional
studies are needed for more complete understanding of the potential of proactive initiatives
necessary to build resiliency skills in FRs. There is a clear call and obligation identified within
these studies, indicating that baseline resilience training for FRs be implemented and cultivated
to prevent more serious conditions developing over the course of a responder’s career.
Governments at all levels must recognize the statistics and the high rates of FRs afflicted with
MH issues caused by repeated exposure to trauma while performing a service to their citizens.
Investment into research, programs, intervention methods and initiatives are the next imperative
steps toward the improvement of this issue.
Training/Education Programs
The study (Hayes et al., 2013) selected for this review indicate that existing MH
programs available to FRs have been largely reactive in nature, and further identified a need to

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emphasize and incorporate proactive strategies and initiatives. The research defined and
displayed meaningful positive outcomes associated with: 1. resiliency training, 2. peer support
training, 3. programs aimed at pre-emptive MH awareness and de-stigmatization, and 4.
changing the psychosocial work environment to promote help-seeking behaviors for FRs.
Exercise
Exercise has many physical and MH benefits. The implementation of exercise regimens
and self-care are also found to be a positive means of promoting resiliency, as well as physical
and psychological health. Professions such as firefighting and law enforcement inherently
require many aspects of physical fitness at the professional baseline. However, less physical
occupations such as nurses, doctors, and emotional support FRs may best benefit from the
implementation of exercise plans, whether done personally or as an agency-wide initiative.
Meckes et al., (2021) study exemplified how physical activity and MH determining factors were
related to the specific roles in being a FR. The results from the study showed a positive
correlation between physical activity and emotional support FRs, and a very low correlation for
traditional frontline FR. The bona fide occupational requirement for physical fitness and agency
implemented fitness standards may require some FR sub-groups (Firefighters, rescue workers,
paramedics etc.) to not only exercise to meet job standards, but also may require demanding
physical tasks when responding to emergency incidents. Fitness requirements for other roles in
FRs may be significantly less and implementing a physical fitness program could be beneficial
toward generating positive MH benefits.
Developing and strengthening resiliency among FRs can significantly contribute to
reducing and even preventing the impacts of trauma related MH issues. Resiliency is one of the
most important deterrents for FRs because it focuses on training mental strength through

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attention and awareness. The research done by Hayes et al., (2013) specifically points to aerobic
exercise as a main contributor toward beneficial changes in the brain regions that are directly
associated with PTSD. Although this research was not specific to FRs, it does display the
potential benefits of applying aerobic fitness as a method for improving symptoms of PTSD
among affected FRs.
The benefits of exercise are positive in most applications and could be seen as an
appropriate method of resiliency and even recovery for FRs. A key takeaway from the studies
reviewed on the benefits of exercise as a key component of maintaining a FRs mental health
fitness. This would be an excellent initiative for FRs because it not only benefits psychological
health, but also physical health which in turn would inherently improve work performance.
Discussion
This research study revealed several linear themes that emerge in relation to the research
question. These themes included proactive MH initiatives, trauma-informed perspectives, destigmatization, peer support, and barriers to access resources. Critical studies such as these must
ultimately be communicated decisively and backed legislatively and implemented
departmentally by those in leadership, leadership education and interdepartmentally.
Overall, the study provided a positive scope of results with respect to pre-emptive
resilience building and harm reduction programming. Some of the commonly agreed upon
recommendations that would have a positive impact on FRs are: addressing resource barriers,
establishing baseline self and peer awareness, and connecting with developed, well studied
programming.

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As for deficiencies, the studies brought forward cannot be generalized in their respective
scopes due to their focus on a specific sample group. Most of the studies suggest resolutions
without providing a definitive endpoint.
The topic of MH crises facing FRs is a challenging one, as there is no clear or simple
answer to how to solve this issue. Psychological issues for an individual can vary greatly.
However, MH is an extremely important aspect of being a FR and must be looked at in-depth in
order to maintain a strong workforce for community safety and response. The gaps that still exist
stem from a lack of comprehensive research on the subject matter, thus making the need for both
qualitative and quantitative analyses to take place. The positive response from programs focused
in peer support, reducing social stigma and encouraging help-seeking are clear from the research
analyzed. Good section.
Recommendations and Direction for Future Research
This research study illuminates the need to prioritize recognition, resources and treatments of
MH issues caused from FRs exposure to trauma(s). The following section provides
recommendations and potential directions for future research from conclusions derived from the
collected and analyzed sources of this research study.
For FR agencies to address stigma appropriately, there needs to be a collective sense of
security, where FRs feel as though they can disclose the issues they are experiencing, without
fear of repercussions to their personal lives and/or career. Seeking help for MH issues in a line of
work, where MH issues are prevalent, must be viewed as a healthy, positive, and proactive
action. The research findings of Smith et al. (2021) suggested holistic approaches to supporting
MH for FRs that encourage organizations to reach-in, rather than placing the full onus of seeking
help on the FR. This also supported the idea of the peer-support initiative. By encouraging a

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supportive culture from the top down, open communication opportunities where FRs can discuss
stressful situations with their social supports, FRs could manage their MH more proactively. In
the research study by Jones et al. (2020), “buy-in” was a term used by interviewed FR
participants referring to the acceptance and support of FR mental healthcare from peers,
administration and their union. Comprehensive support from the level of leadership down is
necessary in order for the associated stigmas related to MH issues can be diminished and/or
eliminated.
Training and education programs for all levels of staff in FR agencies are essential
methods to not only inform the dangers of exposure to trauma, but also increase resiliency,
promote empathy for colleagues, provide methods of self-intervention and create positive
change. From analysis of the research, further research into the elements of an effective FR MH
program or training is needed. While programs such as The Working Mind (Mental Health
Commission of Canada, 2022 a), Here For My Peer (Horan et al., 2021), and the online
delivered Mental Health First Aid (Chowdhary et al., 2019) education program have shown to be
an effective way for agencies to support their FRs, the high rates of PTSD, self-harming
behaviours and trauma induced stresses support the need for further research.
Conclusion
In 2017, in the United States of America 93 firefighters and paramedics died performing
their jobs while in the same year, 103 committed suicide (Heyman et al., 2018). This alarming
figure shows the absolute necessity for appropriate resources to be accessible to FR’s dealing
with MH crises. This research study has covered many topics regarding gaps, barriers to helpseeking behaviour, stigma and accessibility of resources for FRs. Critical analysis of the research
gathered shows that there is no one single solution when creating programs to identify and treat

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MH issues FR experience throughout their careers. Considering that being a FR inherently
involves regular exposure to traumatic incidents, the need for MH programs, mental healthcare
initiatives and awareness is essential to promoting a stronger and healthy FR workforce for
communities. Gaps still exist and are a result from lack of comprehensive and in-depth research
in the subject matter.
Positive impacts on stigma reduction, resiliency, and proactive strategies were observed
(Smith, et al., 2021). Smith et al. (2021) study suggested that organizations should teach and
train proactive resilience training amongst FRs as significantly beneficial to them, improving
their judgment, decision-making actions and quality of life (Smith, et al., 2021). Furthermore,
providing opportunities for crisis debriefing and social support are extremely important as it
allows FRs to interpret and appropriately process stressful situations (Smith, et al., 2021). The
goal of this approach was to normalize communication opportunities that enable FRs to openly
discuss stressful situations with their social support systems. Smith et al. (2021) further identified
stigma as an ongoing barrier that prevented FRs from proactively seeking help, suggesting
that 90% of respondents (in this U.S study) concluded that stigma was the main barrier to
seeking support for their MH.
The information presented identifies a need for future qualitative and quantitative
research to take place. There are obvious benefits of peer-support, use of apps, and
destigmatizing help-seeking behaviours that have been presented in the data from the reviewed
studies. However, considering the complexity of trauma related MH issues facing FRs, further
research is warranted and FRs as well as mental health care providers require more thorough
understanding of the issues to provide better assistance for mental health crises.

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