Keeping Your Head in the Game and Your Boots on the Ground

By David W. Ballard, PsyD
Reprinted from the NVFC Helpletter

Photo courtesy of Lauralee Veitch.

As first responders to fires, automobile accidents, medical emergencies, and other hazardous situations, firefighters are regularly exposed to dangerous and potentially traumatic events. This not only puts firefighters’ physical health and safety on the line, but can also increase risk for PTSD, depression, substance abuse, and other behavioral health concerns. These occupational hazards, combined with the day-to-day stressors we all face (including financial, family, and health issues), stigma related to help-seeking behaviors, and underutilization of behavioral health services require a team effort to keep firefighters at the top of their game, both on and off the fireground.

Mental health takes on a critical importance in high-stress, high-risk work settings, such as those in which first responders operate, where their own functioning has serious implications for the health, safety, and security of the public they serve. Even when it comes to physical health, major efforts to address the needs of first responders didn’t occur until 1987, when the first consensus standard to address occupational safety and health for emergency services (NFPA 1500) was published. The focus on mental health came even later when, in 2004, major fire service organizations acknowledged the importance of psychological support as a priority for the fire service by including behavioral health as part of their jointly developed 16 Firefighter Life Safety Initiatives.

It is well known in the field of workplace health promotion that the costs and performance losses related to mental health issues often outweigh those related to physical health concerns. The U.S. Fire Administration and national fire service organizations have acknowledged a number of behavioral health issues in the fire service that need to be addressed, including firefighter suicide, performance and conduct problems, substance abuse, depression, and conflicts in personal and family relationships. In addition, positive psychological well-being is increasingly recognized as a driver of well-being and job performance.

Recent efforts by the National Volunteer Fire Council and other major fire service organizations shine a spotlight on the importance of firefighter behavioral health and the need to address barriers that prevent firefighters from accessing the services and resources that can keep them healthy and performing at their best.

Stress and Burnout

Stress is a normal reaction designed to help us cope with dangerous situations. Faced with a threat, this automatic response kicks us into gear so we can deal with the problem at hand. The brain triggers the release of hormones that prepare us for a “flight or fight” response to the threat. This causes a number
of changes − it raises blood pressure, heart rate, and blood sugar; suppresses nonessential body functions like digestion; and alters the immune system. Psychologically, it affects our mood, attention, and motivation.

Although the stress response is helpful in high-pressure situations, the human body isn’t designed to withstand the physiological changes that occur over extended periods of time. Chronic stress causes wear and tear on you mentally and physically and can wind up damaging your health, relationships, and job performance.

In some cases, chronic stress can lead to burnout and affect your motivation, confidence in your ability to be successful on the job, and actual work performance. When someone is experiencing burnout, they have an extended period of time when they feel exhausted, unmotivated, and ineffective, and their job performance can suffer. Symptoms of burnout include exhaustion, lack of motivation, frustration, cynicism, and other negative emotions; cognitive problems; a decline in job performance; problems with interpersonal relationships at home and work; not taking care of yourself; being preoccupied with work during leisure time; decreased life and work satisfaction; and health problems.

Research also suggests that burnout can negatively affect people’s decision-making abilities, resulting in more risky, irrational decisions. This is of particular concern to firefighters, who are required to think on their feet in situations that have life-or-death implications for themselves, their fellow first responders, and the people they serve.

Recovering from chronic stress and burnout requires removing or reducing the demands and replenishing your resources. This means carving out some time when you are off duty to stop thinking about work and take steps to recharge.


Mental health stigma and underutilization of behavioral health resources in the fire service is another area of concern. Focus groups funded by FEMA through DHS Fire Prevention and Safety Grants explored the current status of behavioral health programs in the fire service and identified barriers including lack of trust, education, communication, and leadership support, as well as fear of reprisal and stigma.

Although stigma related to mental health issues has declined in general, work is one place where people are still concerned about potential repercussions, such as being passed over for promotions, treated unfairly, seen as weak and less competent, or becoming the target of bullying, social exclusion, or gossip. Since mental health problems aren’t necessarily visible to others, people often go to great length to keep them concealed from their co-workers. This can add to their stress, making the challenges they face even more difficult and preventing them from getting the support they need.

Support starts with good-quality mental health coverage as part of their health care plan, but it doesn’t stop there. Integrating behavioral health and emotional well-being into all of the organization’s health and wellness practices is key. Mental health issues are more common than people think, with about one in three Americans suffering from a diagnosable mental health disorder in any given year. So, it’s important to make mental health a normal part of the wellness discussion.

Strong Leaders

A 2016 survey by the American Psychological Association found widespread links between senior leader support for well-being efforts and a variety of outcomes, with more than 9 in 10 working Americans saying they feel motivated to do their best (91 percent vs. 38 percent of those without leadership support), are satisfied with their job (91 percent vs. 30 percent), and have a positive relationship with supervisors (91 percent vs. 54 percent) and coworkers (93 percent vs. 72 percent). Those with support from leaders were also less than half as likely to say they intend to leave their job in the next year (25 percent vs. 51 percent).

Leaders can help by providing their department personnel with clear information about available resources, such as counseling, and how to access them. But leadership support doesn’t stop with just hanging posters and distributing helpline phone numbers. From arranging training and education about mental health issues and debunking myths about mental illness to serving as role models in normalizing discussion of mental health to helping firefighters access the resources they need and providing
emotional support, leaders can highlight how positive mental health can contribute to a healthy, safe, high-performing department.

With a comprehensive approach and leadership support, principles of wellbeing, including good mental health, can become ingrained in the very norms, values, and beliefs that are part of the fire service culture.

Four Tips for Reducing Stress and Burnout

1. Relax.
Do something that actively helps you unwind, whether it’s exercise, listening to music, reading a book, taking a walk, or visiting with friends and family.

2. Live a little.
Take up a hobby, play a sport, take a class, or do something else non-work related that is interesting, challenging, and engaging.

3. Catch some Zs.
Research suggests that having less than six hours of sleep per night is a major risk factor for burnout. Get enough good-quality sleep. Maintain a regular sleep schedule; make sure your bedroom is quiet, dark, and comfortable; and avoid staring at your TV, computer, tablet, or smartphone right before bed.

4. Get support.
Accepting help from supportive friends and family can improve your ability to manage stress. If you continue to feel stressed out and overwhelmed, or the negative interactions start to affect your sleep, health, job performance, or relationships, you may want to tap in to resources such as Employee Assistance Program (EAP) services, or get a referral to a psychologist, who can help you better manage stress and change unhealthy behaviors.

David W. Ballard, PsyD, MBA is the Assistant Executive Director for Organizational Excellence at the American Psychological Association (APA), where he is responsible for providing leadership, direction, evaluation, and management for all activities related to APA’s Center for Organizational Excellence. The Center houses APA’s Psychologically Healthy Workplace Program (PHWP), a public education initiative designed to promote programs and policies that enhance employee wellbeing and organizational performance. He is also a member of the NVFC’s Health and Safety Workgroup.