As we commemorate 22 years since the tragic attacks on September 11th, it is a good time to remind us about the critical role federal agencies should play in first responders’ health and well-being. Whether on a memorialized day like 9/11 Remembrance Day or during natural disaster recovery efforts like the wildfires in Maui, tremendous human courage and strength emerges. Response teams representing a range of federal agencies and specialty areas, including the departments of Homeland Security, Health and Human Services, Interior, FEMA and more, courageously go into dangerous situations and put their civic duty above their personal well-being. Even after their deployments and assignments have concluded, many of these selfless individuals continue to feel the impact of their challenging and often traumatic experiences, every day.
When it comes to mental health, federal agencies must take steps to educate these brave first responders about mental wellness, erase the stigma around mental health issues and ensure their staff feels safe enough to utilize the resources available to them.
First responders are always at the forefront of each incident or disaster, and they ensure the safety and well-being of the population. It is estimated that 30% of first responders develop behavioral health conditions including, but not limited to, depression and post-traumatic stress disorder, as compared with 20% in the general population.
To tackle the mental health crisis among its federal employees, the departments of Interior and Agriculture established a program that provides mental health training and trauma support services for wildland firefighters. Firefighters are frequently working 800 or more hours of overtime per year as the wildfire season has increased by 80 days since the 1970s. More recently, Sens. Gary Peters (D-Mich.) and Josh Hawley (R-Mo.) introduced a bi-partisan bill to enhance the DHS law enforcement personnel’s mental health resources and suicide prevention programs. As law enforcement agents work at the U.S.-Mexico border non-stop and witness countless traumatic events, this proposed legislation comes on the heels of a reported 15 suicides among Customs and Border Protection employees in 2022, which is twice the number in 2020 and three times as many in 2014.
Three-quarters of 9/11 first responders report at least one physical or mental health condition directly linked to their exposure to the traumatic event. Almost 30% are managing a mental health condition. In the years since 9/11, the federal government has taken steps to support first responders. For instance, in 2010, the World Trade Center (WTC) Health Program was established within HHS. The program provides medical monitoring and treatment benefits for firefighters, law enforcement officers and rescue, recovery and cleanup workers and other eligible survivors. This summer, the Senate voted to allocate an additional $676 million to the program. However, of the estimated 410,000 eligible first responders, only about a quarter have enrolled in the WTC Health Program. During Mental Health Awareness Month earlier this year, bi-partisan legislation was introduced by Reps. Ami Bera (D-Calif.) and Brian Fitzpatrick (R-Penn.) to provide mental health resources to first responders and healthcare workers who are at an elevated risk of suicide compared to other professions.
While these steps taken by the federal government are commendable, legislation and the establishment of programs alone will never be enough if we don’t also address the underlying barriers that prevent first responders from using these resources.
Recognizing the underlying challenges
The shortage of mental health workers, paired with the lingering stigma associated with mental healthcare, prevent many federal first responders from getting support. Today, nearly half of all Americans live in a mental health workforce shortage area. Meanwhile, the demand for behavioral health specialists is steadily rising. Fortunately, federal agencies have Employee Assistance Programs (EAPs) with counselors in place to help navigate life challenges that may affect job performance, health and personal well-being. These licensed professionals are available by phone 24 hours a day, seven days a week, and in-person counseling can be arranged on a case-by-case basis. EAPs allow federal workers to find support quickly and at no cost — but they remain severely underutilized, often because of the stigma that mental healthcare continues to carry for some first responders.
Though there have been some positive cultural changes in the last decade to normalize mental health care, many still perceive seeking support as a sign of weakness. They may also worry that their hours will be reduced, they will lose certain clearances or certifications, or be deemed unfit to carry a firearm. This perception causes many first responders to refrain from seeking help until they reach an extreme crisis point — or forego care altogether.
Eliminating the stigma
The fact that negative perception still exists indicates there is still more federal agencies can do for first responders to destigmatize mental healthcare and prioritize privacy.
One way to destigmatize is simply through conversations and agency messaging. I regularly give talks to colleagues about the mental health spectrum on which we all exist, and the consistently high turnout indicates to me that people want to have open conversations. But federal agencies need to prioritize the discussion by highlighting the variety of mental health resources available and conveying that utilizing these services is normal, healthy and supported.
For example, weekly pop-up screens or email reminders are ways to frequently get information in front of the workforce and encourage EAP participation. Agencies can use these reminders as opportunities to teach their employees about tools and techniques available to help self-assess where they are on the mental health spectrum, identify shifts in their mental wellness, and understand how and when to get help.
Breaking down barriers
For this approach to be effective, first responders need to trust these systems and understand that using EAPs or other workplace-sponsored mental health support is completely anonymous. Federal agencies should emphasize this fact to help put minds at ease. For instance, first responders should know if they can access resources on their personal phones. They may be more likely to explore options from the comfort of their home and from a device where they don’t feel they’re being monitored by their employer.
When disaster strikes, first responders are there for Americans in a time of need; they deserve the same from us today. Federal support and resources are crucial, but destigmatization and privacy are essential parts of the equation to encourage the use of provided resources that create resiliency, improve mental preparedness, and recognize the importance of self-care. First responders carry the weight of their own safety and well-being, as well as those they serve. Federal agencies must break down every barrier that stands in the way of these brave individuals and the care they need to thrive.
Dr. Tifani Gleeson, MD, MPH, FACOEM, is a chief medical officer at Sedgwick Government Solutions. Prior to this role, Dr. Gleeson served in numerous leadership positions in the U.S. Navy, including as associate director of the occupational and environmental medicine residency program, Uniformed Services University.