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Funding EMS behavioral health programs

Results from the 2023 EMS Trend Survey identify an urgent need for increased mental health support


“It is pivotal to prioritize and adequately fund behavioral health programs within EMS departments,” Hursh writes.

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What paramedics want in 2023 is the latest iteration of the EMS Trend Report, produced through a collaboration between EMS1, Fitch & Associates, the EMS Survey Team and NEMSMA, and sponsored by Pulsara.

In this year’s EMS Trend Survey, we turned the lens towards provider stress, and uncovered alarming levels causing providers to rethink their career path, as their rapport with patients, their own relationships and their health suffer. Download your copy for insights from EMS leaders into how to nip provider stressors at the bud and mitigate the downstream effects of understaffing.

By Adam Hursh, MPA, CFO, MIFireE

The nation’s prehospital emergency services are the backbone of our healthcare system, furnishing critical care and support in times of peril. Still, the demanding nature of their work frequently leads to significant stress and internal health challenges for paramedics and EMTs.

To address these issues effectively, it is pivotal to prioritize and adequately fund behavioral health programs within EMS departments. Unfortunately, results from the EMS1 and Fitch & Associates 2023 EMS Trend Survey, reported in “What paramedics want in 2023,” reveals intimidating gaps in the availability of these programs, partially due to funding, pressing the critical need for increased fiscal support. By investing in these programs, we can guard the wellbeing of EMS personnel and enhance the overall quality of care they give.

Stressors faced by EMS personnel

A stunning 57% of respondents to the survey reported that their department leadership does not recognize the stressors faced by the EMS labor force. This lack of recognition perpetuates a culture of neglect, disregarding the internal health and wellbeing of those who devote their lives to saving others. Backing should be allocated to raise mindfulness and educate department leadership about the unique challenges EMS professionals face, nurturing an investigative environment that actively recognizes and tackles their sources of stress.

The current state of behavioral health programs

It is concerning that only a small percentage of EMS professionals have access to crucial behavioral health programs. According to survey respondents, just 6% report that their department offers family counseling, therapy animals or clergy/chaplain/faith-based groups. Additionally, 14% have access to critical incident stress management and after-action reviews, 15% receive peer support, and 17% have an employee assistance program (EAP). These numbers emphasize the urgent need for increased funding and resources to expand behavioral health programs, ensuring EMS professionals can thrive in all aspects of their lives.

Expanding behavioral health support services

The expansion of behavioral health programs in EMS is crucial and must happen on a massive scale. The 2023 EMS Trend Survey revealed that 21% of EMS personnel report that their department does not provide any behavioral health support services. This statistic is deeply concerning, as it means that a massive portion of our EMS labor force lacks access to vital services that assist with managing the emotional risk of their work. To amend this, funding should be directed toward establishing comprehensive and accessible behavioral health support services, including peer support teams, family counseling, and after-action debriefings. These services should be readily available to all EMS personnel, no matter their employment status, rank, or experience.

Perfecting access and trust in wellbeing programs

The survey highlights two significant challenges concerning support programs’ access and trust. Roughly 26% of the participants are unsure if their organization has an EAP or, if they do, how to use it effectively. This emphasizes the need for increased backing to ameliorate communication, education and training on penetrating available coffers. Also, only 13% stated that they trusted their EAP for support, while 11% believed their peer support team was adequately trained. Organizations should work to ensure that the programs offered are properly funded and appropriately disseminated across their entire workforce.

Extending support to EMS families

The wellbeing of the EMS labor force’s families is nearly intertwined with their own internal health. Still, the survey indicated that only 32% of the respondents reported that their department offers their families stress and behavioral health support. This is a missed opportunity to give comprehensive care and support to those indirectly impacted by the same stressors that EMS personnel face.

Increased fiscal support should be allocated to extend support services to the families of EMS professionals. By addressing the needs of EMS families, we produce a more comprehensive and supportive environment where the workforce can thrive professionally and personally.

Funding these necessary programs

EMS organizations have various funding options to cater to the welfare of their personnel. One popular method is the fee-for-service model, in which each behavioral health service, such as substance abuse treatment, is paid for separately.

Reimbursement through Medicaid and other insurers is also an alternative, as they can now extend beyond just transportation services to other healthcare provided by mobile integrated health programs in some states. Certain agencies offer direct billing options to state or state-funded mental health management.

Many EMS organizations can extend support to their employees by simply providing workplace assistance programs to cover mental health treatment costs. Employers or health insurance providers may cover mental health expenses or directly pay the provider for their services.

A new payment scheme called the Directed Payment Program for Behavioral Health Services (DPP BHS) has emerged as a value-based initiative. The DPP BHS is available for Medicaid-enrolled individuals who are cared for using the Certified Community Behavioral Health Clinic (CCBHC) model of care, which combines physical and mental health services in a “whole-person” care approach.

With these versatile payment methods available, EMS organizations aim to promote the prioritization and accessibility of mental healthcare services and support for their staff.

About the author

Adam Hursh is a seasoned fire service professional with 23 years of experience. He is currently the deputy fire chief at the Gilt Edge Volunteer Fire Department and a full-time lieutenant with the Piperton Fire Department, both in Southwest Tennessee. Adam holds a Master of Public Administration from Columbia Southern University and is recognized as a Chief Fire Officer by the Center for Public Safety Excellence (CPSE). He is also renowned for securing numerous local and federal grants for his departments and consulting with other fire and EMS agencies on grant submissions.