There is an enormous and often tragic toll extracted from the lives of first responders by the work they are called to do. Police officers, correctional officers, firefighters, dispatchers, EMTs and paramedics witness horror, devastation and man’s inhumanity to man, yet they are expected to return home unchanged. From academy graduation forward, they are taught not to carry home what they encounter, but erasing horrific images is impossible. Running toward chaos and danger carries an incalculable cost. Many bury sadness, anger, guilt, fear, anxiety and depression until they are crushed beneath wounds that do not bleed. Cumulative trauma comes with the territory. First responders do what they do so the rest of us do not have to. Behind badges, helmets, body armor and gear is a human being with a beating heart and a soul. How soon we forget.

The only salve in the mental health toolbox is to talk about what ails. Catharsis is the solitary answer: empty the backpack and give oneself permission to let it go. These burdens were never meant to be borne alone. First responders are exhausted by excessive demands, toxic leadership, public scrutiny, politics and violence of the worst kind. Mental health concerns have become immeasurable: severe sleep disturbances, substance abuse, uncontrolled anger, family discord, depression, anxiety, accumulated trauma and relentless job stress. Without sleep, coping and decision-making diminish rapidly. For too many, a downward spiral is just around the corner.

A major barrier to providing mental health services is first responders’ lack of trust in the mental health profession. If providers have no experience in military service, law enforcement, corrections, dispatch or the fire service, a barricade stands between public safety professionals and those called to treat them. Clinicians must learn the culture, overcome assumptions, build trust over time, provide relevant training and allow first responders to become their teachers. This cannot be learned from a textbook. Cultural competence requires far more than a ride-along, a meeting with a chief or an occasional roll call appearance. One must embed in the culture.

According to the 2024 “What Cops Want Survey,” which has wide applicability to all first responders, several areas demand greater attention:

• The stigma surrounding mental health services remains a barrier to seeking help.
• Culturally competent services are too often unavailable. Access alone is not enough.
• Investing in wellness programs delivered by seasoned professionals can yield a major return.
• Leadership must move from autocratic models toward transformational, servant and situational leadership (Lee, 2024).
• Supervisors and peers must recognize red flags, including deteriorating performance, fatigue, anger, withdrawal, sick calls and unexpected changes in behavior.
• Improve tools that support resilience, sleep, relaxation, breathing, decision-making, communication, nutrition and productivity.
• Make regular physical exercise part of the workday.

Exhausted, sleep-deprived, overworked, provoked and vilified first responders cannot give the job 100%. Leadership must give wellness the same focus as routine training. PTSD is far more prevalent in first responders than in the general population, making mental health services essential, not optional. Meaningful support following critical incidents is indispensable and too often overlooked. Critical incident stress management (CISM) and peer support should complement one another rather than compete. CISM team members are trained, certified and bound by confidentiality in most states. Their purpose is to help responders return to full functioning and duty while promoting psychological stability and well-being.

CISM reinforces camaraderie and the belief that brothers and sisters on the force have one another’s backs. Critical incidents are sudden, disruptive events that exceed normal coping strategies. CISM helps responders regain their footing when their ability to cope become overwhelmed. Peer support offers compassion through active listening. Though distinct, CISM and peer support can complement one another. Creating an atmosphere where compassion can flourish and worthiness is affirmed is invaluable in the first responder culture (Platoni, 2023).

After traumatic events such as line-of-duty deaths, colleague suicides, mass casualties, child deaths, serious work-related injuries, inmate deaths or prolonged critical incidents with negative outcomes, CISM teams should be activated (Dorie, 2021). This short-term crisis response fits agencies exposed to frequent critical incidents, particularly when employees are flooded with emotions that interfere with their ability to perform their duties. Too often, cumulative trauma becomes a lifelong injury when silence remains unbroken (Hogeland, 2017; Platoni, 2023).

CISM and peer support can coexist peacefully. Peer support is a distinct element within the larger CISM package. Each situation must be assessed carefully to determine the most effective intervention. The onus is on the mental health and first responder communities to make this happen for those who place their lives on the line for the rest of us (Platoni, 2023).

The elusive thing called sleep

Sleep is restorative. Waiting until you are dead to sleep leaves the sleepless in airplane mode. Sleep debt may shorten one’s life. Alcohol is not a sleep aid. It erodes circadian rhythms, disrupts REM sleep and prevents the mental reboot REM provides.

Sleep deprivation impairs judgment, situational awareness, attention, decision-making, teamwork, de-escalation, stress tolerance and emotional control.

Solutions include shutting off devices and social media interactions that trigger an alerting response (Kaylor, 2025).

Helpful strategies include the following (Kaylor, 2025):

• Exercise at least three times weekly to support sleep-wake regulation and stress reduction.
• Take naps when possible, preferably not in church parking lots.
• Cut down on caffeine and stop intake by mid-shift.
• Reserve the bedroom for sleep, sickness and other rest-related needs.
• Build daily de-escalation into your routines.
• Dim lights to mimic sunset and cue the body that it is time to rest.
• Read Why We Sleep by Dr. Matthew Walker (Kaylor, 2025).

Moral injury

Moral injury in the first responder community is immense. This is the psychological trauma that arises when one is placed in a position of violating closely held values and beliefs, whether through action, inaction or witnessing acts that violate those principles. Reactions include hopelessness, guilt, self-blame, isolation, anguish, anxiety, anger and remorse. Moral injuries may predict PTSD symptoms, but they can also stand alone when potentially morally injurious events occur without actual or threatened violence (Blumberg, 2022).

For law enforcement and correctional officers, enforcement actions that conflict with moral values can wound deeply. So, too, can watching supervisors, command staff or co-workers act contrary to one’s values. Policy violations, disrespect, corruption and poor decisions may produce disillusionment, erode morale and shake faith in leadership. The wound of the soul has become widespread in the first responder community.

The response to moral injury is access to competent mental health resources, along with mandated education and training for supervisors and command staff. This subject is rarely discussed, yet self-care initiatives are critical in high-risk occupations. Suffering in silence is not the answer, but it is often the reality until troubling behavior comes to the attention of others. Be aware and beware.

The problem of toxic leadership

Too often, first responders are devalued, disregarded, disrespected and unsupported by departments and commands. Grant-funded wellness programs may have proliferated, yet many personnel who risk their lives every day remain forgotten nonetheless. A check-the-box approach is not a fix. Hostile work environments drive morale into the ground. Excessive punishment in understaffed departments contributes to burnout, stress-related medical conditions and psychological injuries for which there may be no remedy other than quitting or moving laterally. This is what organizational abandonment looks like.

Tworek (2025) writes that first responders are called to save lives, take a life to protect others or make the ultimate sacrifice, asking only for support from leaders and assurance that bonds of trust and family will endure. That promise often fails. Agencies leave employees to flounder alone. The collapse of those bonds leaves isolation, disillusionment and despair, becoming powerful contributors to mental unwellness and, in the worst case, suicide.

Adding to cumulative trauma, abandonment becomes anything but a force multiplier (Tworek, 2025). Realizing that one’s agency will not have employees’ backs can create devastation that is difficult to repair. Who shows up after a critical incident matters. First responders must be treated with dignity and respect and given evidence that the agency truly cares. This is a wake-up call for leadership. The greatest predictor of recovery from first responder trauma is professed and perceived support. Nothing will change until this becomes standard practice.

For all they do to serve, sacrifice and bring cease-fire amid violence, hatred and madness, first responders deserve better. The time is long past due to foster moral integrity, accountability, transparency, dignity and respect, and to ensure access to mental health services from those best equipped to provide them. Blessed are the peacemakers: the firefighters, paramedics, EMTs, dispatchers and all members of the first responder community. They deserve our gratitude, our respect and our unwavering support.

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References

(n.d.). What’s the Difference Between CISM and Peer Support. Crisis Support Solutions. crisissupportsolutions.com/difference-between-cism-peer-support.

Blumberg, D. L. (February 2022).What Should Clinicians Who Care for Police Officers Know About Moral Injury? AMA Journal of Ethics. Volume 24 (2).

Dorie. (2022, January 5). What IS the Difference Between CISM and Peer Support [Video]. Crisis Support Solutions. youtu.be/fWRSLbDy5zc.

Hogeland, R., Retired Firefighter/Paramedic, Dayton Fire Department (2017). Personal Communication.

Kaylor, L. (2024, September 17). The Hidden Sleep Risks Putting Cops at Risk. Podcast. Police 1. police1.com/health-wellness/the-hidden-sleep-risks-putting-cops-at-risk.

Lee, J.M. (2024, August 30).) Crisis point: A wakeup call for police leaders on officers’ mental health. Police 1.

Police 1 (2024) What cops want survey digital edition. police1.com/what-cops-want/digital-edition-what-cops-want-in-2024.

Platoni, K. (2023, September 28). CISM Versus Peer Support. LifeNet. Volume 34 (3). International Critical Incident Stress Foundation, Inc.

Tworek, K. (2025, September). Unpublished Manuscript. Organizational Abandonment-The Family That Isn’t.