Reading time: 3 minutes, 19 sections (820 words)
Mental health professionals assessing or treating first responders with mental illness should understand public safety jobs. This understanding can help professionals make accurate assessments and treatment plans that are meaningful, effective, and appropriate, said Dr. Krystle Martin in a presentation for the International Forensic Psychiatry Lecture Series.
First responders, also called public safety personnel, work in a variety of jobs. Among these jobs are police, paramedics, firefighters, military personnel, and corrections officers, as well as communications personnel and dispatchers for these services.
AI-generated image using ChatGPT
and edited in Photoshop.
Why Job Context Is Important
First responders say they prefer to talk with mental health professionals who understand their jobs, which helps build rapport and trust. However, some say they are concerned that talking about what they experience on the job may harm the mental health professional.
Public safety jobs can affect how a person presents or what symptoms they have. First responders are often exposed to traumatic incidents or stress, but mental health professionals should not assume which incidents are traumatic. Dr. Martin mentioned a first responder who found procedural problems affecting his job more traumatic than seeing people who were dead or dying.
Different jobs may involve different stresses. Paramedics often face emergencies in progress and must take urgent steps. By contrast, police officers typically arrive after the crime has taken place, so their emotions may not be as strong. Corrections officers may face constant uncertainty and threats to their safety in prisons. Dispatchers often deal with very emotional callers. They may feel a lack of resolution because they do not always find out what happened in these situations.
These differences may affect the first responder’s mental and physical symptoms. Mental health professionals should adjust their assessment questions to fit the person’s experience.
First responders’ job experiences can affect their beliefs and views. They may focus too much on safety, overestimate risk, and show rigid thinking about some issues. Those who have experienced trauma at work may constantly scan the environment for threats and prepare to respond. They may feel a burden of responsibility. These feelings can lead to hypervigilance — high sensory awareness and constant scanning of the environment for potential threats. Hypervigilance is a common symptom of posttraumatic stress disorder (PTSD).
Several factors may make first responders hesitant to seek help with mental health.
They often work in collaboration with the mental health system. If they experience mental illness themselves, they may not want to ask for help from someone with whom they also meet on their job.
First responders may blame themselves for mental health problems, believing that the onus is on them to be resilient.
Many learn to suppress emotions when at work to carry out their tasks. However, they may not learn to reconnect with their feelings when tasks are completed. In mental health treatment, first responders may minimize their feelings or restrict their emotions and may take some time to express these.
First responders may identify strongly with their job. When they start work, they are welcomed into a family. Their actions have an impact on all their coworkers. They must keep a high standard of behaviour, even when off duty. If they do something inappropriate and face consequences, they may feel helpless and hopeless.
It’s Not Always PTSD
Because first responders are at higher risk of PTSD than other people, colleagues and union representatives may incorrectly assume the person has this disorder. As a result, the person may expect to get a diagnosis of PTSD. In fact, they may experience depression, anxiety, substance use disorder, burnout, or moral injury rather than PTSD.
When assessing first responders, mental health professionals should make an accurate assessment and carefully consider the diagnosis.
Mental health professionals can help first responders understand that resilience may not prevent mental illness but can help them recover.
Many first responders are trained to make their mission the top priority, followed by the team. They put themselves last. This can conflict with self-care and resilience. Mental health professionals may have difficulty convincing first responders of the importance of self-care.
What Works in Recovery
Dr. Martin surveyed participants in a residential in-patient program to help first responders and military personnel recover from mental illness. Participants mentioned aspects that helped them recover successfully:
- They could trust their fellow participants and feel understood because they came from similar job backgrounds.
- Staff honoured and respected them as professionals, which helped them regain their identity.
- Community outings helped restore their confidence in going out, making friends, and renewing relationships with friends and family.
- They had fun — a sign that they felt safe and relaxed, trusted their environment, and could re-establish connections with other people.
For more details, watch the recording of the March 19, 2026, lecture, “Cultural Competence and System Realities in First Responder PTSD: Implications for Forensic Practice” on our website.
Written by Carolyn Brown and approved by Dr. Krystle Martin.
