Rethink programming for first responder psychological wellbeing

Connection, space and opportunity to express emotions and reality-based messaging are what first responders really need


COVID-19 has ignited a renewed call for programming to support first responder psychological wellbeing. These are truly unprecedented times. We are asking much of first responders and want to ensure they are psychologically healthy.

However, many frontline cops, firefighters and medics will roll their eyes when asked to attend yet another session on stress and resilience. Their reaction is a clue our programming is not landing. We have had decades of CISM, problem-oriented peer support, psychological first aid and resilience training, and the results are mediocre at best. It may be that our messaging and programming is off. This is an invitation to reflect on our goals and the experiences of those we hope to help. 

Most agree that when it comes to psychological wellbeing, what we ideally want are EMTs, paramedics, cops and firefighters who can:

Today, more than ever, we need cops, firefighters, and medics who are passionate about the role, treat it as more than a job and bring their hearts to work every day.  (AP Photo/Matt Rourke)
Today, more than ever, we need cops, firefighters, and medics who are passionate about the role, treat it as more than a job and bring their hearts to work every day. (AP Photo/Matt Rourke)
  • Deliver excellent, competent services without mistakes
  • Provide those services with kindness, compassion, calmness and optimism in environments of high risk, danger, stress and moral ambiguity
  • Do their duty over and over again at all hours of the day and night without breaking down
  • Return home with a deep sense that their service has been worth it
  • Become better human beings, partners, friends, spouses, parents and neighbors because of the role and work    

In reality, we are a long way from achieving this ideal.

For the past couple of decades resilience training, peer support and CISM programming has sent first responders a message that is mostly negative, depressing and contrary to reality. The programming has been problem-focused, reactionary and concentrated on stress, significant events, survival and bouncing back (resilience). The dominant messaging and programming have conveyed the following:

Beware, watch out, and pay attention. Your job is psychologically dangerous. The stressors, risks, significant events, tough calls, trauma, heartbreak and everyday crap you will experience are likely to cause mental breakdown. We want to train you to beware of, mitigate and bounce back from the psychologically dangerous nature of the adversity inherent in your work. 

Yet, when we evaluate the research and study the lived experience of long-term first responders who flourish, and when we reflect on thousands of years of human struggle and development, we should be sending a very different message [1]. Essentially, it is:

Becoming a medic, firefighter or cop has the potential to be an amazing life path filled with adventure, personal growth and satisfaction. This potential exists because of the stress, risks, significant events, tough calls, trauma, heartbreak and everyday crap you will experience. We want to help you cultivate the skills needed to lean into the adversity that is inherent in your work and use the adversity as an engine for more growth and development. This growth and development will lead to deeper levels of satisfaction, fulfillment, meaning and personal wellbeing. 

On the surface, the difference may seem subtle, and the shift only slight. It’s not. Thoughts and beliefs about struggle and adversity determine how we frame experiences and come to view our lives.

Messaging in framing adversity

Imagine Jane and Sally, two young women heading off to college. For years, both have received messages from their parents about college, leaving home and embarking on an independent life. Both parents care deeply about their daughters and want them to succeed.

Jane’s parents frame the inherent struggles and challenges of leaving home as dangerous. Their message is full of warnings, and their focus is on helping Jane develop strategies and skills for avoiding adversity, coping and, when adversity is unavoidable, bouncing back. Wellbeing is framed as learning to cope. Jane comes to view adversity with suspicion and fear.

Sally’s parents frame the inherent struggles and challenges of leaving home as opportunity. Their primary focus is on the satisfaction, fulfillment and the joy of becoming a mature and confident adult. Adversity is treated as a natural and necessary engine to propel growth. Wellbeing is presented as a life skill always needing practice. Sally’s parents focus on helping her develop strategies for leaning into adversity, using adversity as an engine for growth and treating adversity as the contrast needed to appreciate the good times fully.   

Despite good intentions, our dominant messaging about first responder work is sending a message like Jane’s parents. We continue to frame adverse experiences as only dangerous and a formula for mental breakdown. We teach resilience, stress management, the neuroscience of mindfulness, and spiritual and physical conditioning as tools to mitigate what is dangerous. While these efforts have helped some, most find the framing of adverse experiences as only dangerous tiresome and disconnected from reality. In continuing this approach, we are losing something we need and something frontline first responders deserve.

Community’s role in first responder success

Today, more than ever, we need cops, firefighters, and medics who are passionate about the role, treat it as more than a job and bring their hearts to work every day. We need long-term employees who have experienced all the heavy-duty struggles and everyday crap, used it to mature and grow, and are still interested in mentoring a new generation to become successful first responders and successful human beings.

Frontline firefighters, medics and cops deserve to live satisfying and meaningful lives. The path to living well in a high risk, high stress, high responsibility occupation is in creating a positive relationship with adversity. A lifetime of studying human experience led renowned anthropologist and psychiatrist Arthur Kleinman to write, “We tend to think of dangers and uncertainties as anomalies in the continuum of life, or irruptions of unpredictable forces into a largely predictable world. I suggest the contrary: that dangers and uncertainties are an inescapable dimension of life. In fact ... they make life matter. They define what it means to be human [2].”

In my consultancy and ongoing qualitative research, I have learned the following about cops, medics and firefighters:

  • The vast majority do not suffer psychological breakdown. Despite significant events, accumulated misery, working in poorly run organizations and in difficult environments, most do not develop or experience long-term psychopathology. This is supported by numerous quantitative studies. Focusing wellbeing primarily on the prevention of psychopathology does not resonate with the troops. Living well, cultivating inner strength and working with adversity is much more interesting.
  • There is a big gap between career expectations and reality. Most cops, firefighters and medics enter the field with high expectations. They expect the role will be much more than a job. They hope to perform meaningful work, have an adventure and reap a better life because of the work. Over time, many continue in the role, but their expectations drop precipitously. The role becomes a job. The job becomes work characterized by routine, dissatisfaction, boredom, cynicism, discouragement and frustration. The evidence for this decline in expectations can be seen in how many say they would not recommend being a medic, firefighter or cop to someone they love. 
  • When listening carefully, we find the primary stressors are not the dramatic and traumatic events. The primary stressors are poor bosses, operational frustrations, politics, schedules and the inability to balance home and work. The dominant survival strategy is a rather dark application of grit, martyrdom and victimhood.
  • Those who flourish know how to rock and roll with adversity. Long-term first responders who express high levels of satisfaction, fulfillment, equanimity and meaning, and show up most days with cheer and enthusiasm are those who prioritize personal growth, development and maturity. They have a unique relationship with struggle and adversity, and thrive in all kinds of departments and work environments. For them, wellbeing is not an aspirational state of mind but the skills needed to reject victimhood and take ownership of their lives, happiness and wellbeing.
  • First responders do not need to hear about the signs and symptoms of mental breakdown, PTSD and suicide during a crisis or in the immediate aftermath of a big event. Reducing an experience to psychopathology robs them of the significance and meaning of the experience. The need is for connection, belonging, recognition, deep listening, encouragement, rest and meaning-making. This is how first responders clean up and recharge.

Humans are endowed with a high capacity to carry stressful and traumatic events communally. The communal part is essential. The image of the lone hero who processes his or her pain alone is mostly a myth. In a crisis or the aftermath of a crisis, first responders need to be seen, appreciated, tended, cared for, loved and connected to others who get their experience. They want to hang out together during and after the big stuff because they don’t feel judged or analyzed. They want to be around those who can appreciate all the quirky and dark ways of talking about their experiences and memories – not a team designed to debrief them. They need to be around people who are known and trusted – not psychological or spiritual experts who are neither.

The needed healing and meaning-making is a natural process that happens organically as:

  • People connect with trusted others
  • They receive legitimate and trusted expressions for appreciation for their service
  • Emotions are allowed to be felt and expressed without judgment or pathologizing
  • They get the time, space and opportunity to grieve and mourn in any way that is natural for them
  • They have the repeated opportunity to tell their stories to empathetic ears and weave the raw hard experiences and memories into the tapestry of meaning that is their life story

Messaging and programming for psychological wellbeing must reflect reality. With the right guidance and support, humans – by design – use adversity as an engine for growth. Merely standing up more messaging and programming based on the beware-this-is-only-dangerous theme may make leaders feel good, but it will not interest the majority of first responders, and it will not help them live well. There is another way.

References

1. In qualitative phenomenology research, the term "lived experience" is a term that refers to everyday experiences of a person and the knowledge gleaned from these experiences. Phenomenology, as a research method, seeks to fully describe a person's lived experience of an event or experience.

2. Kleinman, A. (2006). What really matters: Living a moral life amidst uncertainty and danger. New York, New York: Oxford University Press.

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