First responders are classed among the workers most exposed to traumatic and stressful events. The nature of their work can leave them vulnerable to developing mental health difficulties such as depression, post-traumatic stress disorder, secondary traumatic stress, relationship difficulties or substance misuse issues. While it is widely accepted that as a result of their work, first responders can benefit and often need professional support to address issues and negate the impact of their work, there is a great reluctance to engage in support seeking behaviour.

For therapists wanting to work with first responders, it is important to have an understanding and appreciation for some of the perceived obstacles first responders face when attempting to access Mental Health support. Understanding these barriers will assist a therapist in working in a culturally sensitive and aware manner, and providing a professional level of care.

What are the barriers to mental health support for first responders?

There are a number of potential barriers when it comes to seeking mental health support amongst first responders. Before looking at these, it is important to highlight how these barriers are heavily influenced by the culture that exists among this cohort of workers. First responder culture can be viewed as a double edged sword: on the one hand it can provide a considerable level of support and understanding from colleagues, while on the other overall well-being can be inhibited because of tightly held views and beliefs. Organisational culture can, over time, become internalised and influence how its member feels, acts and thinks. The impact of this cultural influence is often quite strong and repercussions vast, with first responders actively avoiding mental health support and attempting to resolve their difficulties on their own. This often leads to the development or acquisition of maladaptive coping strategies. Some of the barriers that are recounted in various studies include:

• Stigma around Mental Health

First responders may avoid psychological support because they want to avoid being labelled as having a psychological disorder. While stigma around mental health is slowly changing, some first responder cultures still endorse negative mental health stereotypes. Individuals who work in a culture that promotes stigma associated with mental health can adopt these beliefs and develop low self-esteem.

• Fear of perceptions of Weakness

First responders may be slow to seek out mental health support as there is a belief that it is a sign of weakness or failure. First responder culture rewards physical toughness, emotional restriction and independence,  therefore seeking out assistance is not compatible with the masculine perception associated with these roles.

• Confidentiality Concerns

First responder agencies can have access to internal or external sources of support, eg. Employee Assistance Programmes and private psychological support. The belief that certain services are not entirely confidential permeates first responder culture. First responders may have concerns of the mechanisms utilised in order to access supports and how this can impact confidentiality.

• Career Consequences

Asking for help is often viewed as risky behaviour, because there could be adverse career consequences, and if was common knowledge it could have a damaging affect no one’s reputation/career.

• Lack of Trust

A distrust of outsiders pervades first responder cultures. The idea of not being able to trust anyone because there are consequences is formulated early on, with police officers and ambulance personnel reporting this view being ingrained in them by their peers/supervisors. This lack of trust is extended to mental health providers, who are seen as outsiders, who would not understand first responder culture or what it is like to perform these roles.

• Not fit for purpose

First responders are uncertain concerning employee assistance programmes and what is actually being provided, who it is these programmes are supposed to support or benefit or for what purpose. The term ‘lip service’ will often be uttered concerning these services as the belief is that they are in place just to satisfy or promote an organisations public perception.

How can therapists effectively engage with first responders?

Working with first responders requires a therapist to have an understanding of the complex and unique needs that can present with this particular group. There are a number of steps a therapist can take to work with first responders in a manner that meets these needs.

Firstly, be aware of the barriers they may face when it comes to accessing mental health support. These barriers may not be relevant to all personnel, however, these beliefs and views permeate all first responder cultures and may be impacting clients on some level. In addition to this awareness, a considerable amount of time may be required to develop a trusting relationship. This trust can be developed by the therapist demonstrating the capacity to educate themselves on the daily workings of these roles, and gaining an insight and understanding of how these organisations operate and what it might be like to work in such an environment. Indicating awareness and appreciation around paper work demands, excessive workload, overtime, lack of resources, poor training etc can all contribute towards this trust and a feeling of being understood in the client.

As confidentiality is of utmost importance to this cohort of workers, it may be prudent to spend extra time around this at the contracting stage, especially if working in a private capacity, and ensuring the client knows that you are there working for them and not their employer. There are other steps therapists can take, within reason, to support first responders, such as flexibility around appointments. Clients may be engaged in shift work, so a set day and time may not work, especially if they do not want to disclose to their supervisor whether they are attending for support or not.

Without adequate support first responders are at a higher risk of developing mental health difficulties which can impact their overall well-being and their job performance. Despite barriers that may exist, it is essential that therapists are in a position to provide a high level of professional care that ensures they remain resilient and effective in their roles while also enhancing the quality of their lives.

What resources are available for counseling first responders?

Best Practices for Counselling First Responders is an extremely useful and informative resource for therapists wishing to work in this area.This is a framework that is guided by four main tenets that include Culture, Systems, Assessment and Treatment. While this publication refers to first responder agencies in the USA, the framework and its components are applicable to all first responder communities and can be of great assistance to therapists working in this area.

To find our more about Peter and his work go to  – https://www.pimlicocounsellors.co.uk/directory/peter-ryan/ or https://peterryantherapy.com/