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First Responder Behavioral Health

Illustration of brain with lightning and public safety symbols

First responders witness many critical incidents throughout their careers, and the repeated exposure to these traumatic events can take its toll. Rates of post-traumatic stress disorder and depression for firefighters and police officers has been found to be as much as five times greater than the general population, according to a Ruderman Family Foundation white paper. First responders are also more likely to die by suicide than they are to die in the line of duty, and the Firefighter Behavioral Health Alliance estimates that only about 40 percent of firefighter suicides are reported.

All first responders need to be aware of the health risks their jobs present, and they need to know when they need help and how to get it. Organizational leaders and coworkers also need to establish work environments that provide adequate training, protect from overwork and support public safety personnel seeking help when they need it.

Some conditions first responders should look out for in themselves and their coworkers:

  • Depression: Mental health disorder characterized by persistent depressed moods or loss of interest in activities. This affects how you feel, think and handle daily activities, such as sleeping, eating or working.
  • Post-traumatic stress disorder (PTSD) or symptoms: Disorder where you have ongoing feelings of stress or fear, even when not in danger. Symptoms that last more than a month and interfere with relationships or work may be considered PTSD.
  • Suicide ideation: Thinking about, considering or planning suicide.
  • Substance use disorder (drug addiction): Disorder affecting a person's mind and behavior, leading to an inability to control the use of a legal or illegal drug or medication. The continued use of these substances changes normal behaviors and interferes with your ability to work or have good relationships with friends and family. Note: Substance use disorder does not require that a person be physically or psychologically dependent on a substance.

Immediate Help

If you are a first responder experiencing emotional distress or are thinking of taking your life, get help from:

Be Well Indiana
Call: 2-1-1 (available 24/7)
Visit: bewellindiana.org

IDHS EMS District Managers
Call or email the district manager for your area: 
Contact list

SAFE CALL NOW
Call: 206-459-3020 (available 24/7)
Visit: safecallnowusa.org

National Suicide Prevention Lifeline
Call: 1-800-273-8255 (available 24/7)
Text: 741741 
Visit: National Suicide Prevention Lifeline (Indiana)

Paramedics for Emotions: Critical Incident Stress Management Teams

There are more than 40 Critical Incident Stress Management (CISM) teams throughout Indiana, made up of trained peer volunteers who arrive on scene to offer care for fellow first responders before they leave an incident, or may give one-on-one attention or group help in the days after. Considered a form of psychological first aid, CISM teams practice a method of helping first responders who have experienced incidents that can leave emotional or physical harm. CISM helps public safety personnel cope with these experiences so they can continue to stay on the job serving their communities and do so without developing long-term negative consequences such as post-traumatic stress disorder (PTSD) or substance use disorder.

CISM volunteers are often firefighters, EMS personnel, police officers, dispatchers or chaplains. In responding to incidents, they try to match up with those with similar backgrounds needing help; for instance, they seek to connect firefighters with CISM volunteers from the fire service. CISM teams are like some peer support programs but differentiate themselves with more of a mental health and wellness approach, involving clinicians as necessary.

Individual first responders or agencies can request help from a CISM team. As a statewide network of CISM teams formalizes, Indiana State Police department staff chaplain Daniel Coffey serves as the point of contact and can be reached at 317-234-4637 or dcoffey@isp.in.gov.

Be Well Indiana and Indiana Suicide Prevention

Be Well Indiana is an initiative by the Indiana Division of Mental Health and Addiction (DMHA) to help connect Hoosiers with support resources in the areas of stress and anxiety, suicide prevention, addiction, domestic violence and more.

Map of Indiana
Indiana Suicide Prevention
Resource Map (interactive)

Integrated with the Indiana 211 crisis hotline, Be Well Indiana’s representatives are trained to serve people across demographics, including first responders. First responders can use 211 themselves or as a resource to refer people to. Many first responders, including police and 911 dispatchers, have dialed 211 for real-time help or to connect callers to the hotline for crisis help.

Benefits of 211
  • It's local. Calls answered by Hoosiers.
  • Available 24/7
  • Anonymous
  • Short wait (about 15 seconds)

First responders and public safety agencies can access various community mental health centers around the state to connect with mental health professionals.

Map of Indiana
Indiana Suicide Prevention
Resource Map

Next Steps

Critical Incident Stress Management (CISM) teams or chaplaincy network: To get connected to volunteer with a nearby CISM team, or if you are a chaplain who would like to coordinate efforts statewide, contact Indiana State Police department staff chaplain Daniel Coffey at 317-234-4637 or dcoffey@isp.in.gov. Coffey also oversees the state police employee assistance program (EAP). Visit the ISP Department Staff Chaplain webpage to learn more about the services offered.

First Responder Suicide Prevention Training (IDHS Online Course): Take the IDHS mental health course on the Acadis Portal to learn the signs and symptoms to look for, risk factors and questions to ask first responders who are stressed or may be suicidal.

Code Green Campaign Programs: The Code Green Campaign offers several first responder-oriented programs and services. For example, read stories from first responders about their  mental health experiences, or share your own.

Confidential Suicide Reporting Form: The Firefighter Behavioral Health Alliance collects data about first responder suicides so that it can better understand the factors at play and share that information to help improve proactive training and suicide prevention. Departments can report the data confidentially online.

Suicide Prevention Toolkit: Use the toolkit for first responders from the Indiana Department of Health. It offers protocols and policies for agencies, "tuck" card template, guidance for families, tips on how to suicide-proof a home and listings of suicide trainings for first responders. Also: Toolkits for other demographics

IDHS First Responder Suicide Prevention Training (Online): Take the IDHS mental health course on the Acadis Portal to learn the signs and symptoms to look for, risk factors and questions to ask first responders who are stressed or may be suicidal.

Share the Load Program: The Share the Load Program is a free nationwide 24-hour hotline for firefighters and EMS personnel. Created by the National Volunteer Fire Council and American Addiction Centers, the hotline  is a confidential service for first responders to receive guidance from another first responder who answers the phone. Call 1-888-731-3473 for help dealing with family issues, substance abuse, stress, mental health and more.

Firefighter and EMT Suicide Screening: Take this online self-assessment from the Firefighter Behavioral Health Alliance to help you understand whether you are experiencing symptoms of depression and suicidal ideations.

Indy Public Safety Foundation Counseling Service: First responders and family members of Indianapolis-Marion County public safety agencies can contact the foundation's counseling service for free (available 24/7). Email frontline@indypsf.org to get connected.

Critical Incident Stress Symptoms and Tips: Download this CISM PDF for symptoms to look out for and tips for dealing with critical incident stress.

Identifying Substance Misuse in the Responder Community: Learn the signs that you or another responder may have a substance use problem by downloading this PDF from the Substance Abuse and Mental Health Services Administration.

Preventing and Managing Stress: Discover how to deal with stress before you engage in emergencies with these stress management skills. Find more first responder stress resources, including online courses, from the Substance Abuse and Mental Health Services Administration website.

Suicide Prevention Toolkit: Use the toolkit for first responders from the Indiana Department of Health. It offers protocols and policies for agencies, "tuck" card template, guidance for families, tips on how to suicide-proof a home and listings of suicide trainings for first responders. Also: Toolkits for other demographics


'First Responders Living With Personal Tragedy'

Excerpt from the April 2019 Hoosier Responder

On a cold night in November 2018, volunteer firefighter Paul Wines arrived at the scene of a possible hit and run that left two men lying on the road. His experience working with the Walton Community Fire Department in Cass County trained him well to expect the unexpected on injury calls.

As he leaned in to begin treating the patient, a familiar face peered back at him. Wines found himself struggling to save his own son. Unfortunately, his injuries were too severe. His son died there in the roadway — beginning a time of turmoil and despair for Wines, who would go on to question every decision he made that night.

"For years, I worried about my son's safety when he started driving," Wines said. "When I heard the tones of a call, I always thought, 'Where is he and is he safe?,' but that slowly went away because I knew he was a safe driver. So, those thoughts weren't on my mind when that call came in. I never thought it could have been my son."

After the funeral was held and the final condolences trickled in, his family fought hard to get back to some sense of normalcy. All the while, Wines struggled with questions about what he should have or could have done better, faster. The experience began to weigh heavily on his mental health. First responders see tragedy every day, but responding to his own son's fatal accident led Wines to consider suicide to escape the pain. Read the full story