Framing the narrative on mental health of First Responders - a layman's opinion
Share your experiences, lessons learnt and thoughts in the comments!
Almost without fail.
Whenever people find out I was a former firefighter, the inevitable question would be — “what’s the worst thing you’ve seen on duty?” (I’m certain this is a shared experience for First Responders the world over). Sure, I could tell the stories of guts (sometimes literally) and glory (most times not).
There’s the gory aftermath of road traffic accidents… bobs and bits of human anatomy sticking out in physics defying ways… to the downright bizarre (read: things stuck where they really have no business in).
And that’s just but a sliver of the First Responder experience. There are violent “customers” harassing First Responders going about their jobs, repeatedly missing key moments of life with loved ones and that nagging feeling that the odds have been stacked against you from the inside (read: manpower and cost cuts - “do more with less”, so they say).
Having been a part of the industry, I was subject to similar stressors. I’m now able to reflect upon my own experiences and string together the thoughts I’ve been brewing with greater candour - the opinions here are from my own experiences, observations and interpretations.
Framing the narrative
Let’s examine how the narrative has been framed. As an example, this worrying description of a “mental health crisis” among First Responders illustrates experiences and interventions at the individual level. This seems to be the prevailing narrative (and indeed, a crucial one) best driven by a small number and passionate number of highly qualified (by education or professional experience) practitioners.
PTSD-like trauma from acute experiences of daily emergency response situations is perhaps the most apparent, and its ample documentation has attained institutional attention. Indeed, First Responders had it rough, way before COVID. It is troubling that volunteers too, are vulnerable to such effects resulting from their volunteer experiences - are the same attention, resources and institutional support be extended to volunteers auxiliary to professional emergency response services?
Less obvious but equally (or more) insidious, is the psychological distress built up over years on the job. For females, who are still a minority within emergency services, the stress and strain may even be compounded at the intersection of gender and the professional culture (ah, toxic masculinity - such a rich and loaded discussion topic, but for another day).
These are larger issues rooted in structural and cultural factors which continually reproduce a mismatch between supply and demand of mental health well-being for First Responders. It is through this framethat I offer my commentary, as a complementary narrative on the matter.
What’s the worst case scenario - could it be existential?
Why the urgency? Left unaddressed, this could devolve into an existential crisis - as First Responder mental health issues proliferate, people leave the profession for self-preservation. Work is picked up by those who remain, adding additional stress and strain to the physical, mental and emotional load amid rising public expectation for quality emergency services.
What really scares me is the prospect that the inability to address these challenges may make a career as a First Responder in the emergency services so unattractive and unviable as a career, especially amid the smorgasbord of career paths available today. How might talent continue to be attracted and retained?
To the extreme, emergency services may simply become un-staffable (both in terms of quality and quantity) to meet society’s high-level of demands today.
Causes for cautious optimism
Well, I would like to think that there’s hope, and here are my observations on a few converging trends that may be cause for cautious optimism.
(1) Awakening institutional change through political action and legislation
One signal is the increasing top-down support and awakening political will to institutionalise structures for holistic (including mental health) care for First Responders. This is observed through some of the shifts in legislation and commitment of state resources intentionally directed into mental health and wellness programmes specifically for First Responders.
Although the level of support likely differs based on where you are, it does seem like some precincts are hitting the mark with initiatives focusing on accessibility of mental health care, building up or strengthening peer support networks and providing in-house specialist services.
Non-profit and community organisations such as the Emergency Service Foundation (with whom I am not affiliated, but am a keen admirer of) are dedicated to provide formal and informal support structures to safeguard mental health and resilience of First Responders. There has been considerable success in mobilising a sustainable ecosystem to bridge shortfalls in governmental action (again, depending on where you are reading this from). The impact of this work could yet be scaled in bigger ways.
(2) New generation, new culture?
We are the result of our time and environment. As Edwards Deming remarked:
Every system is perfectly designed to get the results it gets.
The “system” is the modern emergency management and incident command system (for an interesting but non-academic account of the birth of the contemporary ICS in North America, check this out!) - in most cases, effective, well oiled machines which form the prevailing paradigm of emergency response.
First Responders in emergency response organisations are typically organised into well-defined command and control structures - rigidly hierarchical, authoritarian and demanding conformation to group norms. This has served the needs of society well for decades. While crucial for mission success, an unintended consequence is perhaps the professional cultural of valorising machismo, and a discomfort of openly addressing deeply personal issues such as mental health.
Whist the “boomer” generation are convenient targets of criticism, due credit should be given to those who wisened up to advocate change for the future. It is for incumbent on the new generation to shift towards a healthier (happier?) culture. Championing mental health should also be celebrated - for example, in the Singapore Civil Defence Force, being appointed as a Paracounsellor (as part of a peer-to-peer support network) is a badge of honour (literally!). This is something to be encouraged, and leaders should be expected to create and protect safe spaces to normalise conversations on mental health across the ranks.
(3) A new era of emergency response structures?
At the broader level, there are indications that the business model of emergency response is evolving. New innovative approaches such as crowdsourcing for emergency response have popped up in various forms, from the myResponder in Singapore, to the United Haztalah in Israel.
Whilst volunteers and community-based response are not novel, its convergence with technology and the spread of basic Lifesaving skills has made the concept of community first response (CFR) for emergencies viable to be scaled up nationally (this gave rise to SCDF's catchy vision - “A Nation of Lifesavers”). There is also greater integration of community partnerships into frameworks for resilience, or Community Based Emergency Management (CBEM) being institutionalised.
Why is this is an important step forward ?
The emphasis is on brokering collaboration and relationships with the community in everyday emergency preparedness and response. This is the big shift in traditional relationships for emergency response organisations - from viewing the community as passive recipients, to the community co-delivering emergency services. Besides improving outcomes by providing timely Lifesaving interventions, mutual empathy could be engendered through this partnership, which would hopefully catalyse necessary community resources mobilised to support First Responders. I believe that we will better off strengthening of social capital between First Responders and the community.
(4) How about technology?
It is so so SO easy to see technology as a silver bullet. Similarly, it may be tempting to just write off tech solutions to what seems to be innately human problems. I’d spend some time here, bear with me, please.
There are popular mobile applications such as HeadSpace and Intellect which aim to put mental health and wellness services into the hands of consumers, including First Responders, alongside a number apps designed specifically for First Responders. The good news is, the emergence of such tech-driven solutions suggests strong commercial interest in the space of mental health - emergency response leaders would be remiss not to ride this wave. If a cultural barrier to traditional forms of professional help was a lack of anonymity, maybe technology could provide a viable alternative with greater anonymity and lower costs?
Technology is not meant as a wholesale replacement of traditional professional intervention, but the enabler of an upstream model of managing emotional and mental health risks. A modest objective might be to relieve pressures in small doses and focusing on de-escalating stress to manageable and less unhealthy amounts.
Other technologies such as virtual reality have also provided new ways of helping First Responders manage stress better when dealing with the daily vicissitudes of Lifesaving. There is also research interest in exploring the applications of VR to promote relaxation, reduce stress and help to regulate emotion. I for one, am looking forward to keeping calm in the “Metaverse” from the comfortable confines of my home.
Of course, technology, is not without its risks. Data, is always a double edge sword. Who owns digital mental profiles, and how will the data be interpreted? Would it be used to perpetuate certain mechanisms of social exclusion? With great power comes great responsibility, and boy, is data powerful.
Can technology provide the answer? In time to come, perhaps, and probably as an important part of a larger system. One thing for certain - technology is should not be a bandaid to gloss over cracks in the structure or delay the much needed broader systemic changes.
How far we have come, how far we have to go - a Call to Action
To many First Responders who live out the dire realities day-to-day, perhaps improvements will never be enough. Interventions for complex issues are themselves complex in nature. It would be folly to simply copy and paste solutions from faraway - mental health is experienced in hyper-local contexts, and thus would need hyper-localised solutions.
Institutional and systemic change has to be continually driven towards a convergence of the trends discussed - (1) institutionalising change through legislation, (2) changing mindsets across generations, (3) evolving business models of emergency response, and (4) leveraging technology and encouraging its uptake.
What can we, as individuals do?
From my unqualified, layman perspective, I do think we each have a part to play. For a start, keep lobbying for, and embracing the changing culture and structure - evolve with the times. As individuals (especially if we hold positions of influence), we set the pace and tone by being more accountable for our own emotions and state of mind. We need to afford ourselves our own space to be human as well.
Some big questions remain, which might be ripe for academic inquiry, for example:
How might we address this issue upstream, and minimise mental health issues of First Responders by design rather than just being satisfied with the low-hanging fruit of “better treatment”?
How might we strengthen institutions and mainstream structures to build upon the progress made? While progress is laudable, much is still contingent on externalities such as political economy, labour markets and other market forces.
From a global perspective, how might we figure out the unknown variables that affect us all differently - for example, is the situation similar for First Responders in Southeast Asia? Latin America? Africa? The Middle East?
How do we make better sense of the research, practices and lessons in promoting better mental health practices as a community of Lifesavers?
Is there more to be done? Definitely! A good start would be to map the landscape to correctly identify the structural and institutional factors that have inhibited action, and design a systematic plan of action.
One recurring theme is the positive effects of peer-to-peer models of support and sharing to generate solidarity and to build up a collective resilience.
Indeed, this is the very reason this newsletter has been set up - to provide that safe space and platform to share tips, opinions and ideas for personal strategies, organisational and even structural interventions to safeguard our Lifesavers out there.
Share your experiences, lessons learnt and thoughts in the comments (feel very free to disagree - constructively - let’s have an open conversation)! If you would like to share your views more privately, feel free to email me directly instead at lifesaver@thelifesavingcollective.com
I believe in the collective power of the crowd, so that we may learn and grow stronger in our solidarity. I look forward to compiling and seeing what wisdom the crowd has to provide.
Your points are well-made, and I particularly appreciate the community-based approach - for all branches of first responders. Thanks for giving us some important things to weigh out, Leon.
Arianna Huffington once said in an interview that culture is the immune system of the organisation, and I really like her analogy. It is something we tend to take for granted and when neglected for too long, it becomes weak. I think Covid was very revealing of an organisation’s ‘immune system’ - it surfaced cracks that mostly manifested in the form of mental health. At the core of it I think it’s always helpful to remind ourselves that we are humans with limited abilities, and at the same time allowing others(co-workers, including our bosses) to be humans too! 🙂