New York State

First Responder
Mental Health Needs
Assessment

THE

BENJAMIN
CENTER
Final Report | 2025 SUNY NEW PALTZ
Benjamin Center for Public Policy Initiatives
Institute for Disaster Mental Health
Robin Jacobowitz, Ph.D.
Amy Nitza, Ph.D.
Kathleen (kt) Tobin, Ph.D.
Jesse Hazard
Table of Contents

Executive summary....................................................................................... 1
I. Introduction and background.................................................................5
II. Literature: First responder mental health........................................5
III. Research design and method.............................................................6
A. On-line survey.....................................................................................6
B. Focus groups......................................................................................8
IV. Findings........................................................................................................9
A. Stressors and challenges of first responder work...............9
B. Mental health impacts of first responder work.................. 18
C. Barriers to seeking mental health care................................. 24
D. P
 rogramming and services to address mental
health challenges........................................................................... 31
V. Discussion..................................................................................................37
VI. Conclusion............................................................................................... 39
Works cited.................................................................................................... 40
Appendices.................................................................................................... 42
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PHOTO: CAMILO JIMENEZ

Executive Summary
I. Introduction and background SUNY New Paltz to design and implement New York’s
First responders are regularly exposed to high-stress inaugural first responder Mental Health Needs Assessment
situations, traumatic events, and life-threatening (MHNA).
environments. The constant barrage of intense scenarios
and critical incidents, along with daily chronic stressors II. Mental Health Needs Assessment: survey and
of the job (e.g., long work hours), places first responders focus groups
at significant risk for burnout and for developing mental MHNA findings and analysis are based on a representative,
health conditions such as post-traumatic stress disorder statewide web survey of first responders and qualitative
(PTSD), depression, and anxiety (Abbot et al., 2015; focus groups. The research team interviewed and
Stanely et al., 2016; SAMHSA, 2018). The mental well- consulted with NYS first responder officials throughout
being of first responders deserves attention, especially the study design process. The study was conducted and
given their critical role in maintaining public safety and this report was written by the research team at the
providing emergency assistance. Benjamin Center for Public Policy Initiatives at SUNY
New Paltz, in collaboration with IDMH and in
New York State Division of Homeland Security and consultation with DHSES.
Emergency Services (DHSES) has made the mental
health of first responders a priority. As part of this effort, i. On-line survey
DHSES and the Institute for Disaster Mental Health The survey sampling frame included specific first
(IDMH) at SUNY New Paltz have collaborated to responder occupations across New York State: law
develop and implement a series of mental health initiatives. enforcement (sworn and civilian), emergency medical
This includes a partnership with the Benjamin Center at services, fire service, emergency communications,

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emergency manager, and administrative. Representation health care were identified as significant challenges
was also sought from career first responders and by approximately three quarters of first responders
volunteer first responders, those with varying years of (79 percent and 75 percent, respectively).
service, and distribution throughout the ten regions
of New York State.1
ii. Mental health impacts of first responder work
Findings about first responders’ personal experience of
The survey was launched on February 26, 2024 and mental health challenges stemming from their work and
closed on April 17, 2024. The total number of respondents self-reported prevalence of mental health conditions are
was 6,931. The final sample after data cleaning and reported here.
weighting was 6,003. Data were weighted by region
to adjust for representation of first responders across • Reflecting on the first responder field as a whole,
New York State. 94 percent of first responders reported that stress was
a challenge for their community, followed by burnout
ii. Focus groups (90 percent), and anxiety (87 percent). [Data in
Focus groups were conducted in the summer of 2024. Appendix B.]
The final focus group sample included 20 first responders • Stress was experienced personally by more than
across the five occupation groups, with varying lengths of two-thirds of first responders (68 percent), followed
service, career/volunteer status, and with representation by burnout (59 percent) and anxiety (52 percent).
across NYS.
• A majority of first responders reported having
III. Mental Health Needs Assessment: findings experienced symptoms associated with the mental
MHNA findings are separated into four dimensions: health condition depression (53 percent) and
i) stressors and challenges of first responder work, approximately 4 in 10 first responders experienced
ii) mental health impacts of first responder work, symptoms associated with the mental health condition
iii) barriers to seeking mental health care, and PTSD (38 percent).
iv) approaches to address first responder mental health. • Thoughts of suicide were reported by 16 percent
of first responders.
i. Stressors and challenges of first responder work
Stressors encountered by first responders fall into four iii. Barriers to seeking mental health care
categories: critical incidents, social challenges, practical Barriers to seeking mental health care fall into four
aspects of the work, and workplace challenges. categories: social barriers, potential consequences,
logistical barriers, and support-related barriers.
• Of critical incidents, traumatic events were cited
as a cause of stress by the majority of first responders •E
 ight in ten first responders reported stigma as a social
(56 percent). barrier for the first responder community (80 percent),
• Public perception of the profession and not enough time followed by concern that peers will think they are
to spend with family and friends (45 percent each), unreliable (78 percent).
followed by difficulty with colleagues (40 percent), were • Potential consequences for seeking care, such as
reported as stressful social challenges. concern about negative career impact and the fear
• Shiftwork, risk of being injured on the job, and overtime, that leadership would treat them differently, were
as practical aspects of first responder work, were cited cited as concerns by three-quarters of respondents
as stressful by approximately 4 in 10 first responders. (74 percent each); fear of losing pistol license was noted
as a concern by approximately 7 in 10 respondents
• Workplace challenges were identified for the field as (68 percent).
a whole; toxic work culture and lack of access to mental

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• Not enough time and scheduling concerns were noted personnel attributed this to the high stress of their
as logistical barriers by 78 percent and 72 percent of work environment: fielding urgent calls continuously
respondents, respectively. over an 8–10-hour shift, lack of closure (emergency
communications personnel are often unaware of
• Approximately three-quarters of respondents reported the outcome of a call), and exclusion from crisis
not recognizing the need for care and lack of culturally debriefings all contribute to the stress of this particular
competent mental health providers as support-related first responder occupation.
barriers to seeking mental health care (78 and 75
percent, respectively). • I n general, career first responders reported greater
stressors and mental health challenges than volunteers
iv. Approaches to address first responder mental health though rates are high for all. Barriers to seeking care
Developing effective approaches to addressing the mental were also felt more strongly by career first responders,
health challenges faced by first responders is essential particularly those related to duty assignment and
for first responders’ own personal health and for job security.
maintaining the efficacy and reliability of emergency • Overall, mid-career first responders reported
services as a whole. experiencing stress, mental health impacts, and
barriers to seeking care more than those in the early
• First responders expressed interest in training, or later stages of their career.
seminars, or educational programs about stress • Stigma remains a substantial barrier to seeking care.
management, coping with anxiety or depression, First responders were concerned that seeking care
and awareness about mental health challenges. would make them “look weak” and that leadership
• Access to physical activity (gym membership or and their colleagues would treat them differently.
in-house equipment), health/nutrition support, group This sentiment may be shifting, however; several
activities/team building, and paid time to seek mental respondents reported that recent attention to issues
health care/mental health days were also suggested as of mental health is chipping away at this stigma,
strategies to address mental health of first responders. and that younger generations appear to be more
• Respondents reported that individual therapy and comfortable with, and open to, acknowledging and
peer support programs, if accessible and free, have addressing issues of mental health.
the potential to improve mental health of the first Relatedly, a fear of consequences, such as light-duty
responder community. assignment, loss of employment, and loss of pistol
license, prevented first responders from seeking mental
IV. Discussion health care. Many first responders asked for clarity
The majority of first responders report significant stressors, about job-related, and other, consequences of seeking
mental health challenges, and obstacles to accessing mental health care.
support. These issues are prevalent across all groups, • Leadership at all levels plays a crucial role in creating
though some variation by occupation, service type, and cultures that support, or harm, the mental health
service length could offer useful insights for targeted of first responders. Relatedly, leadership is key to
interventions. Overall, the primary takeaway is clear: the successful development, implementation, and
many first responders face considerable mental health reception of mental health initiatives and services
challenges as a result of their work. within the first responder community.
• Mental health providers with very particular
• While rates are high for all, emergency communications
experience in, or deep knowledge of, first responders’
personnel had among the highest ratings for stressors
work, experience, and culture are most trusted
and mental health impacts relative to other first
to provide care. There is currently a dearth of
responder occupations. Emergency communications
these providers.

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Some promising ideas to address issues of first responder

mental health surfaced from the MHNA:

• Development of a statewide or regional peer support

network, trained to address first responder issues
and available 24/7. This team would be the first line
of support for struggling first responders and would,
when appropriate, refer clients to a professional who
had already been vetted for experience, availability,
and insurance (including tele-mental health).
Confidentiality of this peer support network
(and other peer support programs) is an important
issue that needs to be attended to in this model.
• Development of a cadre of culturally competent
therapists, through the creation of a first responder-
focused certificate or micro-credential that can be
taken as part of graduate mental health counseling
programs. Participants could receive first responder-
specific training at training centers or through ride-
alongs with first responders.
• Mandatory annual, or more frequent, mental health
wellness checks.
• Access to wellness activities, such as gym
memberships, department-wide events, and collegial
activities that connect first responders to their peers
and the community.
• Policy-level discussions, and introduction of legislation
where appropriate, about ways to mitigate stress in
work environments (e.g., long hours, overtime, training
for leadership) and increase access to mental health
care (e.g., reduced co-pays, discounted services, paid
time to seek care).

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I. Introduction and background

First responders are regularly exposed to high-stress and promoting workforce resilience and a peer support
situations, traumatic events, and life-threatening program to serve as a resource and promote mental health
environments. The constant barrage of intense scenarios and well-being among the first responder community. In
and critical incidents, along with daily chronic stressors of addition, IDMH partnered with the Benjamin Center
the job (e.g., long work hours), places first responders at at SUNY New Paltz to design and implement New
significant risk for burnout and for developing mental York’s inaugural first responder Mental Health Needs
health conditions such as post-traumatic stress disorder Assessment (MHNA). The MHNA documents first
(PTSD), depression, and anxiety (SAMHSA, 2018). The responders’ perspectives on the stressors of first responders
mental well-being of first responders deserves attention, work, mental health challenges, the barriers to receiving
especially given their critical role in maintaining public mental health care, and potential beneficial responses
safety and providing emergency assistance. and interventions. The MHNA survey was disseminated
across New York State in spring 2024; focus groups were
The New York State Division of Homeland Security conducted over the summer. This report details the survey
and Emergency Services (DHSES) has made the mental and focus group findings and provides program and policy
health of first responders a priority. As part of these recommendations for promoting and supporting the
efforts, DHSES and the Institute for Disaster Mental mental health of the first responder community into
Health (IDMH) at SUNY New Paltz collaborated to the future.
develop and implement training in managing stress

II. Literature: First responder mental health

As frontline response to emergencies and disasters, the first on the scene of medical emergencies, experience
first responders regularly face challenging conditions, intense stress from delivering critical care under time
traumatic scenes, and urgent situations. Exposure to pressure, witnessing severe injuries, and dealing with
hazards and risks is inherent in this work. Some hazards fatalities (Donnelly et al., 2016). Emergency communications
are psychologically jarring, such as shootings, motor officials field urgent calls throughout their entire shift, but
vehicle accidents, natural disasters, and threats to personal are often unaware of the outcome of an incident and are
safety (Marmar et al., 2006), while others, such as long often not included in incident debriefs, resulting in a lack
shifts, interrupted sleep, and physical challenges of the job, of closure for this first responder group (Smith et al., 2019).
are more insidious (Patterson et al., 2012; SAMHSA, Regardless of first responder occupation, most must also
2018; Igboanugo et al., 2021). The dramatic shocks from deal with the stress of irregular work hours, shift work, and
traumatic incidents and the slow burn of sleep deprivation, mandatory overtime in their everyday work schedule
lengthy work hours, and physical exertion can contribute (Igboanugo et al., 2021).
to a range of mental health challenges from overall stress
and burnout, to depression, PTSD, anxiety, and This chronic and pervasive stress, from traumatic events
depression (SAMHSA, 2018; Queiros et al., 2020). to everyday strain, can significantly impact the mental
health and wellness of first responders. Empirical research
The sources of stress can differ within different has highlighted alarming rates of psychological distress
occupations in the first responder community. Law among this population. Some analyses reveal that first
enforcement officers frequently confront violent crime, responders are at greater risk of developing mental health
life-threatening encounters, and the need for high-stakes conditions, such as PTSD and depression than the general
decision-making under pressure (Violanti et al., 2018). public (Abbot et al., 2015; Henderson et al., 2016; Stanely
Firefighters are regularly exposed to traumatic events such et al., 2016; Benedick, 2007). Jones et al (2018) found
as fires, accidents, and natural disasters (Jahnke et al., high rates of depression (14 percent), anxiety (28 percent),
2016). Emergency medical services (EMS), who are often symptoms of PTSD (26 percent) and substance abuse

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(31 percent) among first responders (see also Alexander further deter first responders from seeking mental health
& Klein, 2001; Benedek et al., 2007; Abbot et al., 2015; care. These individuals may worry about being treated
Stanely et al., 2016; SAMHSA, 2018). Research also differently by their peers and superiors or facing career
shows high rates of suicidal ideation among first repercussions, such as reassignment to administrative
responders (Stanley et al., 2015; Abbot et al., 2015; work, loss of service weapon, or loss of security clearance,
Violanti et al., 2008; Chopko et al., 2014). Even within if they acknowledge a struggle with mental health issues
the first responder community, mental health impacts (Alexander & Klein, 2001).
can vary by first responder occupation, type of first
responder service (career vs volunteer), and length of first Taking risks to help others is the essence of a first responders’
responder service (Stanley et al., 2017; see SAMHSA, job. And, at the same time, the work can have damaging
2018 for a review). effects on first responders’ personal lives and relationships,
their physical health, and their mental health. The MHNA
Despite all that first responders confront on the job, will provide a clearer understanding of the challenges
they can be reluctant to seek assistance for mental health faced by first responders and the barriers to seeking care,
challenges. Some barriers are logistical; irregular schedules while identifying and promoting the development of
and long shifts can make seeking help—and receiving programs and services to address these needs.
regular care—difficult. Concerns about confidentiality
and potential negative impact on their careers may

III. Research design and method

The MHNA findings and analysis are based on a PTSD, depression) were examined. The research team
representative, statewide web survey of first responders reviewed existing surveys of first responder mental health
and qualitative focus groups. The research team in the academic and policy literature to develop an
interviewed and consulted with NYS first responder understanding of the current research in the field.
officials throughout the study design process. This study
was conducted and this report was written by the From this work, the research team developed a bank of
research team at the Benjamin Center for Public Policy questions for potential inclusion in the MHNA survey.
Initiatives at SUNY New Paltz, in collaboration with The research team then consulted with IDMH and
IDMH and in consultation with DHSES. DHSES to review the question bank, add new questions,
subtract those deemed not relevant, revise language, and
A. On-line survey define criteria for inclusion of first responder occupation
i. MHNA survey construction (e.g., law enforcement, EMS, fire service). A draft survey
The MHNA survey was developed through an iterative instrument was constructed from this process and was
process of literature research, review, and feedback from then returned to IDMH and DHSES staff for review.
first responder officials and first responders themselves. Changes and suggestions were incorporated, and
The research team conducted an extensive review of another draft was created. Five first responders were
the literature about issues of mental health in the first asked to pretest and provide feedback on this draft.
responder community, stressors of first responder work, Further changes were made, and the instrument was
impacts of first responder work on mental health, revised and improved, and then finalized.2
perceptions of mental health issues within the first
responder community, barriers to seeking care, the notion For the purpose of the MHNA, first responder occupations
of stigma as it relates specifically to mental health, and include law enforcement, fire service personnel, emergency
programs/services and delivery mechanisms that could management services, emergency communications officials,
potentially aid first responder mental health. The specific emergency managers, and those in administrative roles.
symptoms that comprise mental health conditions (e.g., The “other” category includes search and rescue, spill/

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TABLE 1
Survey sample, NYS First Responder population, by occupation and NYS region, weighted

Sample percent Estimated population

Sample count
of cases percent, NYS

OCCUPATION*

Law enforcement 1,763 29% 30%

Emergency medical services 2,229 37% 12%

Fire service 3,127 52% 49%

Emergency communications 417 7% 3%

Emergency manager 512 9% <1%

Administrative 346 6% 5%

Other** 77 1% —

NYS REGION

Western NY 349 6% 6%

Finger Lakes 313 5% 5%

Central NY 246 4% 3%

Southern Tier 226 4% 2%

North Country 192 3% 3%

Mohawk Valley 170 3% 2%

Capital Region 454 8% 6%

Mid-Hudson 900 15% 15%

Long Island 1,380 23% 23%

New York City 1,752 29% 35%

* Respondents could choose more than one occupation, hence total responses are greater than the number of survey respondents. The percent of cases category
also sums to more than 100%; these proportions are the prevalence among the survey sample, which is of relevance for this work.
** Includes search and rescue, spill/radiation emergency response, animal emergency response, hospital police, and probation officers.

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radiation emergency response, animal emergency response, TABLE 2

hospital police, and probation officers. Focus group counts

Occupation First responder count

The MHNA survey is grounded in four primary themes:
sources of mental health distress stemming from first Law enforcement 4
responder work, the mental health challenges experienced Emergency medical services 4
by first responders as a result of their work, barriers to
Fire service 4
seeking mental health care, and potential beneficial
programming and services. The final MHNA survey Emergency communications 5
instrument contained 27 questions, including background Emergency managers 3
and demographic items, such as length of service, type of
Total 20
service (career/volunteer), age, gender, and NYS region of
first responder work.
The total number of respondents, prior to data cleaning,
The MHNA survey was programmed for online data
was 6,931. The final sample after data cleaning and
collection using Qualtrics survey software. A consent
weighting was 6,003. Data were weighted by NYS region
form was integrated into the introduction of the MHNA.
to account for representation of first responders across
Responses were anonymized so that personally-identifying
New York.4 Estimated total population parameters are
information, including IP address, was not collected.
based on counts provided by the U.S. Census and
statewide organizations. Table 1 shows the weighted
ii. Sampling and data collection
sample distribution across first responder occupation and
The sampling frame included specific first responder
NYS region.5
occupations across New York State: law enforcement
(sworn and civilian), emergency medical services, fire
iii. Analytic approach
service, emergency communications, emergency
Data were evaluated through basic descriptive statistics.
management, and administrative. Within these criteria,
Variable measurement was either nominal or ordinal.
representation was sought for career and volunteer first
There were several opportunities for qualitative response.
responders, those with varying years of service, and
Qualitative responses were coded by theme and analyzed
distribution throughout the ten regions of New York
as such; thematic qualitative data analysis was applied as
State as defined by NYS Empire State Development.3
well. Several variables were combined to create composite
measures to represent specific mental health conditions
The survey link was disseminated by DHSES first to
(PTSD and depression). Internal consistency was
county-level first responder organizations in law enforcement,
estimated using Chronbach’s Alpha.
fire service, EMS, emergency communications, and
emergency managers. These contacts were invited to
B. Focus groups
forward the link directly to first responders in their
i. Construction of data collection instrument
respective fields and to local leadership who, in turn, were
The research team used focus groups to gather more
asked to forward it to their departments. The link was
in-depth information about the mental health challenges
also disseminated through DHSES’ first responder
facing first responders. The protocol was developed by the
training database. Low response rate from New York City
research team, in collaboration with DHSES and
and Long Island prompted additional outreach efforts to
IDMH. The final question sets and prompts focused
those geographic areas.
specifically on sources of stress, barriers to seeking care,
and potential solutions.
The survey link was launched on February 26, 2024 and
closed on April 17, 2024.

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“I’m smiling on the outside but

sobbing on the inside. I try my best Three of the focus groups were underattended. DHSES
to seem strong and unbothered. But and IDMH reached out to county and statewide contacts
to recruit additional participants.
if someone asked me if I was okay
I would probably break.” The final focus group sample included 20 first responders
across the five occupation groups, with varying lengths of
service, career/volunteer status, and with representation
ii. Sampling and data collection across NYS. Table 2 shows focus group distribution across
The focus groups were organized by first responder first responder occupation.
occupation, with consideration given to type and length
of service, and NYS region. The research team organized iii. Analytic approach
one focus group each for law enforcement, fire service, Researchers coded the transcripts from each focus group
EMS, emergency communications, and emergency separately and then met to discuss and refine codes.
managers, with a goal of 5 participants in each group. This process was used to ensure inter-rater reliability.
Researchers then used a thematic approach to data
The research team developed recruitment materials that analysis. Final codes were determined and then applied
included an introduction to the study, a consent form, during an analysis meeting of the research team.
and a date and time for each meeting. This information
was programmed into Qualtrics. A Qualtrics link was
disseminated by DHSES to county-level first responder
organizations. Respondents were able to voluntarily
register to participate in the focus groups.

IV. Findings
Findings are separated into the four dimensions of the source, the stressors of first responder work are often
MHNA: stressors and challenges of first responder work, chronic and pervasive.
mental health impact of first responder work, barriers to
seeking mental health care, and approaches to address The MHNA survey posed questions about the stressors
first responder mental health. Analyses examine first and challenges of first responders’ work. These stressors
responders in total, then by occupation, type of service fall into four categories: critical incidents (Figure 1, Table 3),
(career vs. volunteer), and length of service. MHNA social challenges (Figure 2, Table 4) practical elements of
survey and focus group data are reported together. the work (Figure 3, Table 5), and workplace challenges
(Figure 4, Table 6). Figure 5 and Table 7 report the impact
A. Stressors and challenges of first responder work of these stressors on first responders’ personal lives. Data
The stress of first responder work is rooted in different are explored for the first responder community as a whole,
sources, including critical incidents, such as motor vehicle for each first responder occupation, by type of service
accidents and shootings; practical elements of the job, (career/volunteer), and by length of service. Detailed tables
such as long shifts or mandatory overtime; and physical appear at the end of this section (Tables 3–7, pg. 13).
demands of the work, such as the endurance required to
get a fire under control or the physical work of securing i. Critical incidents
a scene. Social challenges—public perception of the job, Figure 1 and Table 3 report stress from critical incidents.
limitations on social life, lack of time to spend with A majority of first responders (56 percent) indicated that
family and friends—are also stressful, as is the weight of traumatic events, such as shootings or accidents, have
high stakes decision-making and the underlying worry been a source of distress. Within occupations,
from the possibility of injury on the job. Regardless of approximately two-thirds of emergency communications

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FIGURE
Figure 1 1 ii. Social challenges
NYS NYS
First Responders, critical incidents
First Responders, critical incidents Social challenges were also noted as a source of stress
(Figure 2, Table 4). Public perception of the profession and
Traumatic events 56% not enough time to spend with family and friends were
reported as stressful by nearly half of first responders
Situations encountered (45 percent each). These were felt most acutely by law
44%
on the job enforcement (70 percent and 62 percent, respectively)
0% 50% 100% and emergency communications officials (57 percent,
64 percent, respectively). One first responder found
negative public perception to be a primary source of stress.
personnel and EMS (67 and 64 percent, respectively) and
over half of all other occupations (with the exception of “The only thing that will really change the negative
the “other” category), identified traumatic events as aspects of the [first responder] job and the
stressors arising from their work. [subsequent] negative impacts on first responders
is a complete change in public perception.” Another
While both are majorities, career first responders agreed, “EMS, fire service, and law enforcement
identified traumatic events as stressors more frequently have taken a beating in the public eye from the
than volunteers (59 and 52 percent, respectively). First media sources.”
responders with 10–30+ years of experience cited stress
from traumatic events more frequently than those with Difficulty with colleagues was cited as stressful by 40 percent
fewer than 9 years of service. of first responders, with a majority (55 percent) of
emergency communications personnel citing this
One respondent described the effect of traumatic events challenge. Approximately 1 in 3 first responders
in this way, reported that lack of understanding from family and
“The calls I have responded to have stuck in my friends about their work and limitations on social life
brain and have repeated in my brain more times was a source of distress.
than I can count. I will smell a certain smell or see
something that reminds me of a traumatic call and FIGURE 2
Figure 2
NYS First Responders, social challenges
that will 100% affect me for the rest of the day or NYS First Responders, social challenges
even couple of days…” Public perception
45%
of the profession
Situations encountered on the job, such as domestic violence
incidents and overdoses, were identified as stressors by Not enough time to spend
45%
with friends and family
44 percent of first responders. This stress was reported
most frequently by EMS (52 percent), followed by law
Difficulty with colleagues 40%
enforcement and emergency communications personnel
(both 48 percent).
Lack of understanding
from family and friends 36%
Career first responders cited stress from situations about your work
encountered on the job more frequently than volunteers
(50 percent to 33 percent, respectively). First responders Limitations to social life 34%
with 5–29 years of service cited stress from these
0% 50% 100%
incidents more frequently than those with less than
5 years or more than 30 years of service.

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“Challenging work environments heighten

your stress levels so your stress is already elevated
when a traumatic event happens.”
Career first responders reported social challenges as One survey respondent articulated the stress wrought by
sources of stress with greater frequency than volunteer mandatory overtime.
first responders. Stress from social challenges was reported
more frequently by those in the middle of their careers, “It’s not just my shifts, but when I come to work
10–19 years of service, than those in the early or later years. and other coworkers call in sick and now I’m
mandated to also work their shift. Now my family
iii. Practical aspects life is affected (kids’ schedules, daycare pickups,
Figure 3 and Table 5 examine stress from practical aspects babysitters). That causes a great deal of stress.”
of first responder work. More than one-third of first
responders reported that practical elements of their work, Stress from mandated overtime was also emphasized by
such as shiftwork (39 percent), the risk of being injured focus group participants who discussed the mental and
(38 percent), and overtime (37 percent) are stressful physical toll of working a double shift, particularly when
elements of their job. Paperwork elicits stress for followed by a regular shift; an 8-hour shift that turns
approximately 3 in 10 respondents. Overall, career first into 16 hours, the use of caffeine to stay awake, the use
responders reported encountering these stressors at higher of alcohol to wind down, sleep schedules interrupted,
rates than volunteers. Also, generally, individuals with family responsibilities reshuffled, and often just a few
5–29 years of service were more likely to report these hours between the end of an overtime shift and the
stressors compared to those with fewer (less than 5 years) beginning of a regularly-scheduled one.
and those with more (over 30) years of service.
Many respondents reported that long hours, coupled with
Shiftwork and overtime were particularly stressful for low pay, left them feeling devalued and disrespected.
emergency communications officials, followed closely “We are understaffed and always expected to do more
by law enforcement (64/65 percent and 61/54 percent, with less,” one respondent stated. Another agreed,
respectively). Stress from the risk of being injured on the “Just about every aspect of this job is underfunded and
job was reported most frequently by law enforcement [we get] very little respect.”
(49 percent), emergency managers (44 percent), and
EMS (43 percent). iv. Workplace challenges
Figure 4 and Table 6 show findings about the challenges
that emanate from workplace circumstances for the
Figure 3 FIGURE 3 first responder field as a whole. Toxic work culture was
NYS First Responders,
NYS First Responders, practical aspects
practical aspects cited as a challenge for the first responder field by
approximately 8 in 10 first responders (79 percent), most
Shift work 39%
frequently by emergency communications (91 percent)
and law enforcement (88 percent). Lack of access to
Risk of being mental health care was cited by three quarters of first
38%
injured on the job
responders (75 percent); lack of access to health care
was a challenge for just over half of first responders
Overtime 37%
(54 percent). These challenges were reported more
frequently by career first responders than volunteers and,
Paperwork 28% generally, by those with less than 30 years of service.

0% 50% 100%

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Figure 4 FIGURE 4 Negative impact on family relationships and friendships was

NYS FirstNYS
Responders, workplace challenges
First Responders, workplace challenges also frequently reported (72 and 67 percent, respectively).
Reports of negative impacts are highest among those in
Toxic work culture 79% emergency communications, though large percentages
were reported across all occupations.
Lack of access to
75%
mental health care Career first responders report negative impacts on
various aspects of their personal lives at higher rates than
Lack of access to
health care
54% volunteer first responders across all measures; between
76 and 90 percent of career first responders reported
0% 50% 100%
such impacts, compared to a range of 51 to 68 percent
for volunteer first responders. Experience of negative
Other workplace challenges, specifically related to impact is highest among those with between 5 and
work environments, surfaced as a theme in qualitative 29 years of service.
survey responses and focus groups. According to one
survey respondent, “these surveys always focus too much FIGURE 5
on event-based traumatic experiences. The real issue Figure 5 NYS First Responders, negative impacts
NYS Firston personal negative
Responders, life impacts on personal life
affecting mental health with first responders…is
organizational disregard for personnel, subpar salaries,
Home life 80%
and toxic leadership.”

Participants described the undercurrent of stress Physical health 79%

emanating from challenging work environments. Several
noted work environments that, in the worst case, fostered
Social life 75%
disrespect for workers, bullying among colleagues, and a
culture of bravado that discouraged self-care. Some felt
that this constant tension exacerbated the impact of the Family relationships 72%
traumatic events they encounter in their work. According
to one participant, “Challenging work environments
Friendships 67%
heighten your stress levels so your stress is already elevated
when a traumatic event happens.” This makes managing 0% 50% 100%
stress from traumatic events even more difficult. At the
opposite end of the spectrum, some first responders were
grateful for supportive work environments, and explained
that this helped to mitigate the impact of traumatic
events. “My department has supportive leadership who
have taken the lead on mental health, so people feel like
they can address the traumatic events after they happen.”

v. Negative impact of stress on personal life

Finally, the research team looked at the impact of
first responders’ stress on their personal lives (Figure 5,
Table 7). Three-quarters or more of first responders
reported a negative impact on their home life (80 percent),
physical health (79 percent), and social life (75 percent).

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TABLE 3
NYS First Responders, critical incidents as a source of stress, total and by subgroup

Traumatic events Situations encountered on the

(shootings, accidents) job (domestic violence, overdose)

All Cases 56% 44%

OCCUPATION

Law enforcement 57% 48%

EMS 64% 52%

Fire 58% 41%

Emergency communications 67% 48%

Emergency manager 52% 44%

Administrative 53% 46%

Other 31% 38%

TYPE OF SERVICE

Career (paid) 59% 50%

Volunteer 52% 33%

LENGTH OF SERVICE

Fewer than 5 years 45% 35%

5–9 years 53% 46%

10–19 years 60% 47%

20–29 years 64% 50%

30+ years 57% 38%

Question wording: Have any of the following aspects of your first responder job ever caused you distress (Scale: Check all that apply): (1) Traumatic events (e.g., motor
vehicle accident, domestics, injury or death from a shooting); (2) Situations encountered on the job (e.g., domestic violence, overdose).

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TABLE 4
NYS First Responders, social challenges as a source of stress, total and by subgroup

Lack of
Public Not enough understanding
Difficulty with Limitations
perception of time with from family and
colleagues to social life
the profession friends & family friends about
your work

All Cases 45% 45% 40% 36% 34%

OCCUPATION

Law enforcement 70% 62% 45% 41% 46%

EMS 46% 46% 42% 39% 36%

Fire 33% 37% 35% 34% 29%

Emergency communications 57% 64% 55% 50% 49%

Emergency manager 51% 56% 45% 46% 37%

Administrative 52% 50% 48% 47% 37%

Other 39% 28% 48% 27% 27%

TYPE OF SERVICE

Career (paid) 56% 57% 46% 42% 42%

Volunteer 25% 24% 31% 26% 19%

LENGTH OF SERVICE

Fewer than 5 years 32% 32% 33% 32% 28%

5–9 years 44% 50% 41% 38% 37%

10–19 years 52% 57% 47% 41% 43%

20–29 years 52% 48% 43% 40% 34%

30+ years 42% 32% 35% 27% 23%

Question wording: Have any of the following aspects of your first responder job ever caused you distress (Scale: check all that apply): (3) Not enough time to spend with family
and friends; (4) Public perception of the profession; (5) Difficulty with colleagues; (6) Lack of understanding from family and friends about your work; (7) Limitations to your
social life (e.g., who your friends are, where you socialize).

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TABLE 5
NYS First Responders, practical aspects as a source of stress, total and by subgroup

Risk of being
Shift work Overtime Paperwork
injured on the job

All Cases 39% 38% 37% 28%

OCCUPATION

Law enforcement 61% 49% 54% 41%

EMS 39% 43% 35% 31%

Fire 27% 32% 26% 20%

Emergency communications 64% 23% 65% 18%

Emergency manager 41% 44% 50% 38%

Administrative 41% 36% 40% 43%

Other 24% 41% 34% 39%

TYPE OF SERVICE

Career (paid) 57% 46% 54% 34%

Volunteer 8% 26% 6% 19%

LENGTH OF SERVICE

Fewer than 5 years 26% 32% 25% 23%

5–9 years 42% 43% 41% 29%

10–19 years 48% 42% 48% 32%

20–29 years 46% 41% 42% 30%

30+ years 28% 32% 23% 24%

Question wording: Have any of the following aspects of your first responder job ever caused you distress (Scale: Check all that apply): (1) Shift work; (3) Risk of being injured
on the job; (2) Overtime; (4) Paperwork.

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TABLE 6
NYS First Responders, workplace challenges as a source of stress, total and by subgroup

Lack of access to Lack of access

Toxic work culture
mental healthcare to healthcare

All Cases 79% 75% 54%

OCCUPATION

Law enforcement 88% 78% 52%

EMS 83% 81% 64%

Fire 71% 71% 51%

Emergency communications 91% 84% 55%

Emergency manager 83% 77% 60%

Administrative 80% 79% 58%

Other 86% 79% 57%

TYPE OF SERVICE

Career (paid) 85% 79% 55%

Volunteer 68% 68% 52%

LENGTH OF SERVICE

Fewer than 5 years 74% 69% 55%

5–9 years 81% 77% 59%

10–19 years 83% 79% 52%

20–29 years 80% 77% 56%

30+ years 73% 70% 49%

Question wording: Thinking about the first responder field as a whole, please rate the degree to which you think the following are significant challenges, (Scale: not
significant, somewhat significant, significant, extremely significant): (10) Toxic work culture; (9) Lack of access to mental health care; (8) Lack of access to healthcare.
Percentages reported here are for total responding somewhat significant, significant, extremely significant.

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TABLE 7
NYS First Responders, negative impacts of stress on personal life, total and by subgroup

Family
Homelife Physical health Social life Friendships
relationships

All Cases 80% 79% 75% 72% 67%

OCCUPATION

Law enforcement 86% 90% 84% 81% 78%

EMS 83% 81% 79% 75% 71%

Fire 77% 70% 68% 68% 61%

Emergency communications 93% 93% 91% 84% 82%

Emergency manager 86% 89% 84% 79% 75%

Administrative 88% 86% 78% 78% 72%

Other 72% 72% 68% 63% 55%

TYPE OF SERVICE

Career (paid) 87% 90% 84% 80% 76%

Volunteer 68% 58% 59% 57% 51%

LENGTH OF SERVICE

Fewer than 5 years 64% 60% 62% 56% 53%

5–9 years 83% 81% 78% 71% 68%

10–19 years 86% 86% 81% 78% 74%

20–29 years 87% 84% 78% 79% 73%

30+ years 78% 76% 70% 72% 64%

Question wording: Please indicate whether first responder work-related distress has ever negatively impacted the following areas of your life, (Scale: Not at all, somewhat,
moderately, a great deal): (1) Home life; (5) Physical health; (4) Social life; (2) Family relationships; (3) Friendships. Percentages reported here are for total responding
somewhat, moderately, a great deal.

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Figure 6 FIGURE 6 i. Mental health challenges

NYS First Responders,
NYS First Responders, experience
personal experience of
of mental Figure 6 and Table 8 report findings about the mental
health challenges
mental health challenges health challenges that first responders have faced
personally as a result of their first responder work.6
Stress 68% Overall, stress is the most prominent challenge
(68 percent), followed by burnout (59 percent), and
Burnout 59%
anxiety (52 percent). Stress was reported at the highest
rates by emergency communications personnel
(80 percent) and law enforcement officers (79 percent).
Anxiety 52% Burnout was noted by three-quarters of emergency
communications officials and more than half of all other
occupations. Reports of anxiety were most frequent
Depression 33%
among emergency communications officials (65 percent;
“other” excepted), and by more than half of most other
PTSD 29% first responder occupations.

Depression and PTSD were cited less frequently, with

Substance abuse 10%
approximately 3 in 10 claiming to have experienced
0% 50% 100%
these mental health challenges across all occupations,
with the highest for emergency communications
(49 and 41 percent, respectively).
B. Mental health impacts of first responder work
The pervasive and chronic stress of first responders’ work Reports of substance abuse are relatively low compared
can impact their mental health and well-being and place to other mental health challenges; 1 in 10 first
them at risk for mental health challenges, including responders state they have experienced substance abuse
anxiety, depression, PTSD, burnout, and substance as a result of their first responder work, with a high for
abuse (Bourke et al., 2022; Jones et al., 2018; SAMHSA, EMS (13 percent).
2018; Abbot 2015; Benedek et al., 2007). Some research
has found higher rates of depression, PTSD, anxiety, Compared to volunteer first responders, mental health
and suicidal ideation among first responders compared challenges were cited at higher rates by career first
to the general population (Bourke et al., 2022; Stanley responders; stress (76 to 53 percent), burnout (68 to 42
et al., 2016). percent), anxiety (60 to 37 percent), depression (40 to 22
percent), PTSD (34 to 21 percent), and substance abuse
This section reports MHNA findings about first (13 to 4 percent). Finally, in general, first responders with
responders’ personal experience of mental health 10–29 years of service reported experiencing these mental
challenges (Figure 6, Table 8) and specific mental health health challenges more than those at the beginning or end
symptoms (Figure 7, Table 9). We close with reports of of their career.
mental health conditions, such as PTSD, depression,
anxiety, and suicidal ideation (Figures 8 & 9, Table 10), Some first responders described how mental health
within the first responder community. All issues are challenges impacted their lives. Explaining a reaction to
explored for the first responder community as a whole, traumatic calls, one first responder stated, “I’m smiling on
for each occupation (i.e. law enforcement, fire service, the outside but sobbing on the inside. I try my best
EMS, etc.), by type of service (career/volunteer), and by to seem strong and unbothered. But if someone asked me
length of service. Detailed tables appear at the end of if I was okay I would probably break.” One first responder
this section (Tables 8–10, pg. 21). reported suffering from “job related anxiety, panic
disorder and PTSD” and another described facing

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FIGURE
Figure 7 7 Across symptoms, to varying degrees, career first responders
NYS NYS First Responders,
First Responders, experience
personal experience ofof
mental experienced these mental health symptoms at higher rates
health symptoms
mental health symptoms compared to volunteers. In general, more first responders
with between 10–29 years of service reported these mental
Sleep disturbance 79% health symptoms than those with fewer than five, and
more than 30 years of service.
Diminished interest in
66%
daily activities
iii. Mental health conditions
Hypervigilance 64% Using the DSM-IV as a guide, the research team combined
mental health symptoms into composite measures to
Flashbacks 63% approximate mental health conditions (Figure 8, Table 10).
Post-traumatic stress disorder (PTSD) is measured through a
combination of multiple symptoms associated with PTSD:
Uncontrollable worry 56%
flashbacks, recurring dreams, or spontaneous memories of a
Persistent feelings disturbing event/events; avoiding reminders of a disturbing
of sadness and 56%
hopelessness
event/events; diminished interest or pleasure in daily activities;
persistent and distorted sense of blame of self or others for a
Estrangement 52% disturbing event; estrangement from friends, family, colleagues;
inability to remember key aspects of a disturbing event/events;
Aggressive, reckless
behavior
35% aggressive, reckless, or self-destructive behavior; sleep
disturbance; hypervigilance. Depression is measured through
Thoughts about suicide 16% a combination of two symptoms associated with depression:
persistent feelings of sadness and hopelessness and diminished
0% 50% 100%
interest or pleasure in daily activities. Anxiety is measured by
a single variable: excessive, persistent, and uncontrollable
“ptsd [sic] and anxiety to a debilitating degree.” Another worry and apprehension.
characterized mental health as “by far the biggest problem
in my life…It is crushing like a heart attack.”
FigureFIGURE
8 8
NYS First
NYS Responders, mental health
First Responders, conditions
mental
8
health conditions 8
ii. Mental health symptoms
Figure 7 and Table 9 show the percentage of first
responders who report ever having experienced specific Anxiety symptoms 56%
mental health symptoms as a result of their first responder
work.7 Overall, sleep disturbance was reported by most, Depression symptoms 53%
affecting about 8 in 10 first responders. This was
followed by diminished interest or pleasure in daily
activities (66 percent), hypervigilance (64 percent), and PTSD symptoms 38%
flashbacks (63 percent). More than half of the respondents
0% 50% 100%
reported uncontrollable worry, persistent feelings of sadness/
hopelessness, and estrangement from friends, family, and
colleagues. About one in three first responders indicated
experiencing aggressive, reckless behavior. Thoughts of
suicide were less common, at 16 percent. Emergency
communications personnel reported experiencing most of
these symptoms more than other first responder occupations.

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“Mental health is by far the biggest problem in

my life… It is crushing like a heart attack.”

A majority of first responders reported the symptom Figure 9 shows a comparison of suicidal ideation in
associated with the mental health condition of anxiety MHNA to an estimate of suicidal ideation in the
(56 percent). Fifty-three percent reported both depression general public of New York State.10 These estimates
symptoms and approximately 4 in 10 reported having show that relative to the general public in New York
experienced all symptoms in the survey associated with State, New York’s first responders are four times as
mental health condition PTSD (38 percent). Consistent likely to report suicidal thoughts.
with earlier findings, emergency communications
personnel, career first responders, and those with 10–29 Figure 9
FIGURE 9
years of service were more likely to report symptoms NYS First Responders and general population, suicidal ideation
Suicidal ideation, MHNA and NYS population
associated with anxiety, depression, and PTSD compared
to their peers in other first responder categories.
NYS first responders 16%
iv. Suicidal ideation
Finally, there is deep concern about suicidality within the
first responder community. The research on this issue is NYS general population 4%
variable. Stanley et al. (2015) found a suicide ideation rate
of 46.8 percent among firefighters throughout their career. 0% 50% 100%
Abbott et al. (2015) found that 37 percent of their survey
respondents (EMS) had ever contemplated suicide. In
studies of mental health within law enforcement, Violanti
et al. (2008) found an average rate of 24 percent for law
enforcement who had ever considered suicide, while
Chopko et al. (2014) found that 8.8 percent of law
enforcement had experienced suicidal thoughts within a
shorter timeframe (past two weeks).

Compared with this previous research, MHNA results

about suicidal ideation fall in the lower end of estimates:
16 percent of MHNA respondents reported ever
experiencing thoughts of suicide as a result of their first
responder work (Table 9). While this percentage may
seem small, it corresponds to 960 first responders in our
sample and extrapolates to thousands within the first
responder population.

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TABLE 8
NYS First Responders, experience of mental health challenges, total and by subgroup

Substance
Stress Burnout Anxiety Depression PTSD
abuse

All Cases 68% 59% 52% 33% 29% 10%

OCCUPATION

Law enforcement 79% 65% 58% 37% 31% 11%

EMS 69% 64% 55% 39% 37% 13%

Fire 61% 52% 45% 30% 29% 9%

Emergency
80% 75% 65% 49% 41% 11%
communications
Emergency manager 75% 72% 58% 34% 33% 11%

Administrative 72% 55% 48% 28% 25% 10%

Other 71% 52% 69% 36% 23% 2%

TYPE OF SERVICE

Career (paid) 76% 68% 60% 40% 34% 13%

Volunteer 53% 42% 37% 22% 21% 4%

LENGTH OF SERVICE

Fewer than 5 years 53% 44% 46% 23% 15% 7%

5–9 years 67% 69% 57% 33% 25% 9%

10–19 years 74% 69% 60% 40% 35% 13%

20–29 years 74% 60% 55% 38% 37% 13%

30+ years 65% 45% 38% 27% 29% 7%

Question wording: Have you ever experienced any of the following as a result of first responder work-related distress, (Scale: Check all that apply): (3) General stress;
(1) Burnout; (2) Anxiety; (5) Depression; (4) Post-Traumatic Stress Disorder (PTSD); (6) Substance abuse.

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 TABLE 9
NYS First Responders, experience of mental health symptoms, total and by subgroup

Aggressive, Thoughts
Sleep Diminished Hyper- Uncontrollable Sadness and
Flashbacks Estrangement reckless about
disturbance interest vigilance worry hopelessness
behavior suicide
THE BENJAMIN CENTER

All Cases 79% 66% 64% 63% 56% 56% 52% 35% 16%
OCCUPATION
Law Enforcement 82% 74% 75% 62% 60% 57% 61% 37% 15%

EMS 83% 72% 69% 71% 61% 64% 56% 40% 20%

Fire 77% 62% 57% 64% 50% 53% 46% 33% 14%

New York State First Responder Mental Health Needs Assessment

Emergency
93% 85% 73% 75% 69% 72% 67% 50% 21%
communications
Emergency manager 83% 72% 71% 62% 62% 62% 55% 33% 12%

Administrative 85% 67% 65% 63% 56% 60% 50% 32% 13%
Other 72% 54% 54% 49% 53% 47% 42% 26% 10%

TYPE OF SERVICE

22 x
Career (paid) 85% 74% 73% 65% 62% 61% 61% 41% 19%
Volunteer 70% 52% 48% 60% 44% 47% 35% 23% 10%

LENGTH OF SERVICE

Fewer than 5 years 67% 53% 54% 49% 47% 46% 39% 28% 16%
5–9 years 81% 69% 67% 62% 59% 59% 57% 36% 17%

10–19 years 83% 72% 71% 69% 62% 61% 58% 42% 17%
20–29 years 82% 71% 68% 67% 61% 60% 56% 40% 17%
30+ years 78% 62% 57% 65% 47% 52% 44% 22% 10%

Question wording: Have you ever experienced any of the following symptoms as a result of your first responder work, (Scale: never, occasionally, frequently, very frequently, prefer not to answer): (10) Sleep disturbance; (2) Diminished
interest or pleasure in daily activities; (11) Hypervigilance; (4) Flashbacks, recurring dreams, or spontaneous memories of a disturbing event/events; (3) Excessive, persistent, and uncontrollable worry and apprehension; (1) Persistent
feelings of sadness and hopelessness; (7) Estrangement from friends, family, colleagues; (9) Aggressive, reckless, or self-destructive behavior; (13) Thoughts about suicide. Percentages reported here are for total responding
occasionally, frequently, very frequently.
 THE BENJAMIN CENTER

TABLE 10
NYS First Responders, mental health conditions (composite measure of mental health symptoms),
total and by subgroup

Anxiety symptoms Depression symptoms PTSD symptoms

All Cases 56% 53% 38%

OCCUPATION

Law enforcement 60% 56% 43%

EMS 60% 60% 46%

Fire 50% 48% 34%

Emergency communications 69% 73% 57%

Emergency manager 62% 59% 39%

Administrative 56% 57% 38%

Other 53% 47% 33%

TYPE OF SERVICE

Career (paid) 62% 60% 47%

Volunteer 44% 40% 23%

LENGTH OF SERVICE

Fewer than 5 years 47% 43% 31%

5–9 years 59% 56% 40%

10–19 years 62% 59% 45%

20–29 years 61% 57% 43%

30+ years 47% 45% 28%

Composite measures were created from the following question: Have you ever experienced any of the following symptoms as a result of your first responder work?
PTSD: Flashbacks, recurring dreams, or spontaneous memories of a disturbing event/events; avoiding reminders of a disturbing event/events; diminished interest
or pleasure in daily activities; persistent and distorted sense of blame of self or others for a disturbing event; estrangement from friends, family, colleagues;
inability to remember key aspects of a disturbing event/events; aggressive, reckless, or self-destructive behavior; sleep disturbance; hypervigilance. Depression:
Persistent feelings of sadness and hopelessness; diminished interest or pleasure in daily activities. Anxiety: Excessive, persistent, and uncontrollable worry and
apprehension. Percentages reported here are for respondents responding affirmatively to the single anxiety measure, both depression symptoms, and all of the
PTSD symptoms queried.

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C. Barriers to seeking mental health care i. Social barriers

Even once the stressors and mental health impacts of Figure 10 and Table 11 report the social issues that might
first responder work are identified, seeking help is no easy prevent the first responder community from seeking care
matter. The stigma surrounding mental health issues can for mental health challenges. Across first responder
discourage first responders from admitting they need occupations, stigma was cited by 8 in 10 first responders.
help and fear about judgment from peers and leadership Concern about perceptions of unreliability was voiced by
further add to stigma-based reluctance to seek care. just over three-quarters of first responders (78 percent)
Concerns about potential career impacts, such as and concern about confidentiality was noted by just
administrative assignments and loss of security under three-quarters of first responders (72 percent).
clearances, and practical impacts, including loss of pistol
license, can also deter first responders from accessing Social barriers were reported most frequently by law
critical services. Long shifts and irregular schedules create enforcement (88 to 84 percent), followed closely by
logistical barriers that can further impede/hinder the personnel in emergency communications (84 to 79
process of seeking treatment (Velazquez & Hernandez, percent). Career first responders reported social concerns
2019; Haugen et al., 2017; Karaffa & Koch, 2016). as barriers to seeking care at higher rates than volunteers.
Barriers to seeking care are high across all years of service,
The MHNA survey asked first responders to reflect on though highest for those with 10–29 years of service.
the barriers to seeking mental health care. These fall
into four categories: social barriers (Figure 10, Table 11), The stigma associated with seeking mental health care was
potential consequences (Figure 11, Table 12), logistical raised frequently in the MHNA qualitative responses and
barriers (Figure 12, Table 13), and support-related barriers in the focus groups. One respondent stated:
(Figure 13, Table 14). Outcomes are explored for the first
responder community as a whole, for each occupation “There is a cultural barrier to getting outside mental
(i.e., law enforcement, fire service, EMS, etc.), by type health help in the first responder community…
of service (career/volunteer), and by length of service.11 there is the cultural suppression of males expressing
Detailed tables appear at the end of this section feelings in a male dominated field. The community
(Tables 11–14, pg. 27). is also not good at admitting weakness or
vulnerability.” Other respondents reported that
stigma “is real” and associated it with a fear of
Figure 10 looking “weak” or that “peers will think you’re
FIGURE 10
NYS First Responders, social barriers
NYS First Responders, social barriers unreliable or uncapable of handling the job.” Said
one respondent, “There are strong stigmas
Stigma associated with
seeking mental health care
80% associated with any kind of weakness shown…
mental health is seen as a bit of a joke.”
Concern that peers will think
78%
they are unreliable For one respondent, the stigma was connected to the care
he/she provides to the community:
Concern about
72%
confidentiality “What we need is access to mental health services
0% 50% 100% outside of our own community. I don't want to
receive service from people I work with. We work
extremely close with mental health services; I can't
go to them for help and the next day work with
them providing services to others. They may be
okay with it but to be honest I don't trust that I
won't be looked at differently. We will lose our

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“I have found that the biggest challenge to addressing

my own mental health needs is finding a mental health
provider that understands [my first responder role], can be
trusted, and accepts my department’s health insurance.”

reputation as the savior in trying times, the fixer, Potential consequences for seeking care were raised with
when it [gets] bad who do you call: first responders. frequency during focus groups and in the qualitative survey
We can’t have the stigma attached to us as it would questions. One participant stated that first responders
show a break down in the communities’ risk losing their job, or other work privileges (i.e., security
expectations of us.” clearance) if “they have the courage to come forward and
ask for help.” Concern about negative career impact and
Finally, several respondents suggested that the stigma the fear that leadership would treat them differently were
associated with mental health challenges is less acute pronounced, with several respondents describing their
among younger first responders. “We (the older generation), fear of retribution, discrimination, or (undeserved)
were raised by men that ‘just dealt with it’ so we find it reassignment if leadership discovered that they were
hard to ask for help. This I don’t think will be as hard for seeking mental health care. One first respondent
the younger generation.” reported that colleagues who seek care for mental health
issues “are viewed as an outcast and treated as such,
ii. Potential consequences both by admin. [sic] and their peers.” Said another,
The potential for job-related or personal consequences, “the largest barrier for first responders in seeking mental
such as negative career impact or loss of pistol license, health [care] is internal retaliation.”
were cited as barriers to seeking mental health care by
the majority of first responders (Figure 11, Table 12). One respondent felt that it would be useful to have clarity
About three-quarters of respondents reported that about the potential consequences for seeking care.
negative career impact and concern leadership will treat
them differently were barriers to seeking care for the first “It would be helpful to know what protections
responder field (74 percent each); two-thirds cited concern there are when reaching out for help. I think some
about losing pistol license as a barrier (68 percent). These people don't [reach out] just because they're afraid
potential consequences were reported as barriers most of the consequences. If known, this would assist
frequently by law enforcement, career first responders, people in making a more informed decision about
and those with 10–29 years of service. seeking help. Real discussion of legality of career
impacts, i.e. loss of firearm and clearance vs.
the perception.”
FIGURE 11
Figure 11
NYS First
NYS FirstResponders, potential
Responders, consequences
potential consequences This same issue was raised about the use of medication to
help with mental health challenges;
Concern about negative
74%
career impact “I don’t know if this exists, but psychiatrists with an
understanding of what first responders are allowed
Concern that unit leadership
will treat them differently
74% to take on the job. Many first responders are afraid
that taking medication for depression, anxiety,
Concern about losing PTSD, or anything like that could lead to them
68%
pistol license not being allowed to carry out their job duties or
0% 50% 100% the loss of their rights to a firearm.”

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FIGURE
Figure 12 12
10 respondents. Lack of community support and lack of
NYS FirstFirst
NYS Responders,
Responders, logistical
logistical barriers barriers family support were cited less frequently (58 and 45
percent, respectively). Career first responders claim these
Time 78% issues as barriers for the field more frequently than
volunteers; mid-career first responders noted these
barriers more than their earlier- and later-career peers.
Scheduling 72%

The lack of culturally competent mental health care providers

Expense 66% was a concern that was raised by several respondents:

“I have found that the biggest challenge to

Lack of employer support 65% addressing my own mental health needs is finding
a mental health provider that understands [my first
0% 50% 100%
responder role], can be trusted, and accepts my
department’s health insurance.”
iii. Logistical barriers
Figure 12 and Table 13 examine the logistical barriers that “I met with one [therapist] who didn't specialize in
may prevent first responders from seeking care for mental first responders. While speaking with them helped,
health challenges. Time was the most cited logistical I feel I was never able to open that part of my life…
barrier (78 percent) followed by scheduling (72 percent); [I] never got into the meat and potatoes of calls
expense and lack of employer support were reported less and some of my PTSD.”
frequently (66 percent and 65 percent, respectively).
Emergency communications personnel cited all logistical Several participants described their experience of being
barriers most frequently, compared to other first responder discouraged when, after finally taking the steps to seek
occupations. Career first responders reported logistical help, the provider could not fully understand or relate to
factors as barriers more frequently than volunteers, as did their circumstances. Some were able to persist through
those in the middle of their career compared to those at the frustration to find a therapist who could address their
the beginning or end. concerns; others were not and abandoned their pursuit
of help.
First responders described the difficulty of making time to
pursue mental health care; long working hours and FIGURE 13
Figure
NYS 13 First Responders, support-related barriers
irregular (and often unpredictable) schedules make it NYS First Responders, support-related barriers
difficult to schedule and attend, for example, a regularly
Not recognizing the
occurring appointment. Several survey respondents 78%
need for care
mentioned that cost is a barrier, either because their
insurance does not cover therapy or because providers do Lack of culturally competent
75%
not take insurance. mental health providers

iv. Support-related barriers Not knowing

69%
where to get help
There were several support-related barriers to seeking
mental health care (Figure 13, Table 14). Approximately
Lack of community support 58%
three-quarters of respondents cited not recognizing the
need for care (78 percent) and lack of culturally competent
mental health providers (75 percent) as barriers to seeking Lack of family support 45%
care for the first responder field. Not knowing where to
get help was reported as a barrier by approximately 7 in 0% 50% 100%

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TABLE 11
NYS First Responders, social barriers for field, total and by subgroup

Concern peers will think Concern about

Stigma
they are unreliable confidentiality

All Cases 80% 78% 72%

OCCUPATION

Law enforcement 88% 86% 84%

EMS 81% 78% 73%

Fire 78% 76% 68%

Emergency communications 84% 83% 79%

Emergency manager 80% 80% 77%

Administrative 82% 83% 81%

Other 79% 82% 81%

TYPE OF SERVICE

Career (paid) 84% 81% 76%

Volunteer 74% 73% 66%

LENGTH OF SERVICE

Fewer than 5 years 75% 72% 61%

5–9 years 80% 78% 71%

10–19 years 83% 82% 76%

20–29 years 83% 82% 77%

30+ years 78% 74% 73%

Question wording: The following are issues/stigma-related concerns that might prevent first responders from seeking care for work-related distress or mental health
challenges. Please rate the degree to which you think each statement is a barrier to seeking mental health care for first responder community generally, (Scale: not a barrier,
somewhat of a barrier, moderate barrier, strong barrier, prefer not to answer/not applicable: (3) Stigma. (2) Concern that peers will think they are unreliable in a stressful or
dangerous situation (that they’re not “up to the job”), (5) Concerns about confidentiality. Percentages reported here are for total responding somewhat of a barrier, moderate
barrier, strong barrier.

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TABLE 12
NYS First Responders, potential consequences as barriers for the field, total and by subgroup

Concern that unit

Concern about negative Concern about losing
leadership will treat them
career impact pistol license
differently

All Cases 74% 74% 68%

OCCUPATION

Law enforcement 86% 85% 82%

EMS 75% 75% 67%

Fire 68% 71% 65%

Emergency communications 82% 79% 73%

Emergency manager 78% 77% 65%

Administrative 79% 80% 69%

Other 65% 66% 64%

TYPE OF SERVICE

Career (paid) 80% 78% 72%

Volunteer 63% 69% 59%

LENGTH OF SERVICE

Fewer than 5 years 66% 67% 50%

5–9 years 74% 74% 68%

10–19 years 78% 78% 77%

20–29 years 80% 79% 71%

30+ years 69% 71% 64%

Question wording: The following statements are stigma-related concerns that might prevent first responders from seeking care for work-related distress or mental health
challenges. Please rate the degree to which you think each statement is a barrier to seeking mental health care for the first responder community generally, (Scale: not a
barrier, somewhat of a barrier, moderate barrier, strong barrier, prefer not to answer/not applicable): (6) Concerns about negative career impact, (7) Concern that their unit
leadership would treat them differently, (8) Concern about losing pistol license. Percentages reported here are for total responding somewhat of a barrier, moderate barrier,
strong barrier.

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TABLE 13
NYS First Responders, logistical barriers for the field, total and by subgroup

Lack of
Time Scheduling Expense
employer support

All Cases 78% 72% 66% 65%

OCCUPATION

Law enforcement 82% 78% 66% 74%

EMS 81% 74% 71% 71%

Fire 74% 65% 61% 59%

Emergency communications 89% 84% 75% 76%

Emergency manager 87% 81% 72% 71%

Administrative 80% 73% 66% 66%

Other 81% 73% 71% 73%

TYPE OF SERVICE

Career (paid) 82% 78% 67% 71%

Volunteer 70% 61% 63% 56%

LENGTH OF SERVICE

Fewer than 5 years 74% 69% 65% 60%

5–9 years 81% 76% 73% 68%

10–19 years 83% 77% 67% 69%

20–29 years 80% 73% 66% 70%

30+ years 68% 61% 55% 56%

Question wording: Following are issues that might prevent first responders from seeking care for work-related distress or mental health challenges. Please rate the degree to
which you think each statement is a barrier to seeking mental health care for the first responder community generally, (Scale: not a barrier, somewhat of a barrier, moderate
barrier, strong barrier, prefer not to answer): (6) Not enough time, (4) Scheduling concerns, (5) Too expensive, (7) Lack of employer support. Percentages reported here are for
total responding somewhat of a barrier, moderate barrier, strong barrier.

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TABLE 14
NYS First Responders, support-related barriers for the field, total and by subgroup

Lack of
Not recognizing culturally Not knowing Lack of Lack of
the need for competent where to community family
care mental health get help support support
providers

All Cases 78% 75% 69% 58% 45%

OCCUPATION

Law enforcement 83% 80% 74% 66% 47%

EMS 79% 79% 72% 63% 50%

Fire 77% 70% 67% 53% 41%

Emergency communications 83% 85% 79% 67% 56%

Emergency manager 80% 80% 73% 64% 53%

Administrative 78% 77% 75% 64% 50%

Other 72% 75% 70% 56% 58%

TYPE OF SERVICE

Career (paid) 80% 79% 72% 61% 48%

Volunteer 74% 66% 66% 51% 39%

LENGTH OF SERVICE

Fewer than 5 years 71% 67% 67% 49% 44%

5–9 years 80% 74% 72% 57% 45%

10–19 years 81% 79% 74% 61% 48%

20–29 years 80% 79% 70% 62% 46%

30+ years 75% 69% 62% 55% 39%

Question wording: Following are issues that might prevent first responders from seeking care for work-related distress or mental health challenges. Please rate the degree to
which you think each statement is a barrier to seeking mental health care for the first responder community generally, (Scale: not a barrier, somewhat of a barrier, moderate
barrier, strong barrier, prefer not to answer): (2) Not recognizing the need for care, (10) Lack of mental health providers who understand the needs of first responders, (1) Not
knowing where to get help, (9) Lack of community support, (8) Lack of family support. Percentages reported here are for total responding somewhat of a barrier, moderate
barrier, strong barrier.

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D. Programming and services to address mental

health challenges
Developing effective approaches to addressing the mental
“First responders need confidential
health challenges faced by first responders is essential for online therapy as built in components
first responders’ own personal health and also for
of their paid duties on the job.”
maintaining the efficacy and reliability of emergency
services as a whole. With such critical need and with the
stakes so high for first responders themselves and for the is aligned with first responders’ desire to have leadership
safety of our communities, the MHNA includes an trained to recognize when members of their department
examination of the types of programming and services are struggling with mental health issues. Approximately
that would help first responders cope with the unique half of first responders stated that programming about
pressures of their profession. Detailed tables appear at understanding stigma and mindfulness would be beneficial
the end of this section (Tables 15 & 16, pg. 35). and about 4 in 10 felt that workshops addressing
alcohol and drug abuse (42 percent) and issues of suicide
i. Topics for programming (41 percent) would be helpful. Overall, more career first
Figure 14 and Table 15 show the topics that first responders responders reported these topics as helpful than volunteers,
feel would be helpful in addressing mental health and generally, more first responders with many years of
challenges, if offered as trainings, seminars, or educational service (20–30+ years) felt that these topics would be
programming. Close to 7 in 10 first responders stated that helpful in addressing first responder mental health than
programming that addresses issues of stress management their colleagues with fewer years of experience.
(68 percent) would be useful, followed by sessions about
coping with anxiety or depression (62 percent). Awareness The MHNA survey question about helpful topics for
about mental health challenges as a topic for training was programming was followed by an open-ended option
supported by approximately 6 in 10 first responders; this that allowed participants to offer suggestions of additional
topics. The following are themes that emerged from
Figure 14 this option.
FIGURE
NYS First 14
Responders, programming to address mental
NYS
health First Responders, programming to address
challenges
mental health challenges • Training for leadership/supervisors/management in:
creating supportive work environments (eliminating
Stress management 68% toxicity, bullying, retaliation from the workplace),
recognizing when members of their team are
Coping with struggling, increasing sensitivity to mental health
62%
anxiety or depression challenges of team members.
Awareness about • W
 here to find mental health resources, locally
61%
mental health and confidentially.
• Th
 e connection between mental health and physical
Understanding stigma 54%
fitness and proper nutrition; financial literacy; self-
care; anger management.
Mindfulness 48%
• H
 ow to address workplace harassment/toxicity/
bullying/retaliation (among colleagues and from
Addressing
alcohol and drug abuse
42% management/leadership).
• H
 ow to recognize signs of PTSD, depression,
Addressing
issues of suicide
41% suicidality in self and others; how to recognize
the need for help.
0% 50% 100%

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Training geared specifically toward management and Many first responders wanted training to help them
leadership was a common theme. One participant stated develop an awareness of mental health challenges and
that, “nothing will change with first responders [mental how to identify them in themselves and others.
health] until administrators take it seriously.” Other According to one first responder, training to “identify
participants observed that mental health programming that you may have a mental health disorder/disease to
and support can be stymied by leadership that does not begin with, not just how to find help” is important. This
know how, or refuses, to implement them well. One person continued, “Most…first responders…don’t even
respondent articulated this dynamic: realize or know they have ptsd [sic], alcoholism,
depression and anxiety, etc. because it’s just the first
“Administrators and policy makers say they are responder societal norm to drink and smoke every day
committed to this [first responder mental health], to push the feelings away and ignore.”
but they need to be challenged to prove it. My
department has a peer support team, but the Relatedly, respondents expressed a desire for programming
administration isn’t trained. They don’t know when to help them understand the effects that first responders’
they should be setting up debriefing, they don’t work can have on mind and body.
recognize burnout and they don’t have any
measures in place to address it, they have a history “It would be helpful to understand the many…
of handling things poorly, and aside from paying different ways that the experiences of a first
for a few [first responders] to be trained, there is responder can have an effect on the mind and the
no structure and no budget for any department- ways the body is subsequently effected. For
wide initiatives.” example, prolonged feelings of being ‘on edge’ can
cause the body to stay in fight or flight mode
These sentiments were shared by several respondents who which can then affect breathing, even in non-
felt that workplace stress could be mitigated, or at least stressful situations. I'm sure first responders are
lessened, if management and leadership were trained to experiencing challenges listed in this survey and
create supportive and productive work environments. not associating them with issues of their job, even
One participant reflected that some leadership and though they are related.”
management are better equipped to address issues of
wellness and mental health than others. “Some leadership Several first responders favored pro-active trainings that
are good at addressing mental health issues of their staff, could help develop skills for managing stressful or
and some just aren’t. Some are good about organizing traumatic events. They saw this as a way to buttress against
post-incident supports and some are not.” Training the impact of a critical incident. These trainings would not
leadership in how to address these issues among staff is preclude the need for post-incident follow-up, they were
critically important. Said another respondent, “An careful to point out, but could provide a solid foundation
organization’s leadership will determine its resilience.” from which first responders could deal with the traumatic
events that are an inevitable part of their work.
First responders also wanted their supervisors to have the
skills to identify when their subordinates need mental At the same time, several first responders felt that
health care and support. These respondents advocated for additional trainings or programming would not address
a “specific course for leadership for recognizing stress in the real stressors of first responder work, which they feel
others,” “training for supervisors to recognize potential are rooted in logistical aspects of the work (long work
issues and take action,” and “teaching leadership to hours, forced overtime, difficulty with management). For
recognize situations that could cause a stress response and these respondents, trainings would be a superficial response
encouraging them to proactively debrief instead of to the stress of first responder work. Others argued that
waiting for someone to admit it was disturbing.” there are already too many trainings required of first
responders and that adding more would merely increase

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“Free access to mental health individual counseling and

psychiatry would be life changing. I cannot afford therapy,
and anxiety and depression have been taking a massive
toll…But I don't make enough money or have good enough
medical insurance offered at work to afford help.”
the burden. Making these trainings or programming were some suggestions to increase access. According to
voluntary was one way to address this concern. one first responder,

ii. Beneficial services “Free access to mental health individual counseling

The MHNA survey also asked respondents what and psychiatry would be life changing. I cannot
services, if accessible and free, would help improve afford therapy, and anxiety and depression have
first responder mental health. Figure 15 and Table 16 been taking a massive toll. Can no longer sleep at
show outcomes from this question. Nearly all first night. But I don't make enough money or have
responders (97 percent) reported that individual therapy, good enough medical insurance offered at work to
if accessible and free, would help to improve first afford help.”
responder mental health. Responses for other services
are also quite high; approximately 9 in 10 respondents Tele-mental health services were also mentioned. One
reported that accessible and free peer support programs respondent suggested, “24 hour statewide confidential
(93 percent), couples/family therapy (91 percent), and crisis tele-health culturally competent counseling then
wellness activities (87 percent) would benefit first referral to [a] vetted licensed provider” would be
responders. Positive responses for all these possible beneficial; others felt that fully online services would be
services were high across all occupations, type of service, an important option for some. “First responders need
and length of service. confidential online therapy as built in components of their
paid duties on the job.”
First responders also mentioned therapy as a vital resource
for first responders who are struggling. The issue of Several first responders wrote that services should be
culturally competent therapists was raised again in this integrated into departmental structure and budgets, to
context, as were issues of access. Free therapy services, ensure their existence and sustainability.
co-pay waivers, paid time to seek care, the ability to take a
“mental health day,” and on-site mental health providers “The challenge is not the lack of services specifically
—I know that there are resources available and
FIGURE 15 [my department] does a superb job of critical
Figure 15
NYSNYS
FirstFirst Responders,
Responders, benefical
beneficial servicesservices incident stress reviews. The challenge is more that
these are exception based and not a significant
Individual therapy 97% structural part of ongoing (especially volunteer)
operational procedures.”

Peer support programs 93%

Couple and family therapy 91%

Wellness activities 87%

0% 50% 100%

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First responders offered ideas about other helpful services. Other respondents expressed caveats about peer
The following themes emerged from this option. programing. Concerns about confidentiality and
appropriate training for peers to counsel others
• Access to physical exercise were raised frequently. One respondent cautioned,
• Health/nutrition support “Peer support groups can be great but…they are
• Peer support programs very contingent on the people involved. I know
• Group activities/team building—hiking, bbq, [colleagues] whose agencies have [unsupportive]
bowling, etc. management run programs that are afraid of
repercussions so will not attend.”
• F
 ree mental health services (very important that
providers are culturally competent) Many respondents suggested that first responders should
• Paid time off/mental health days be required to receive regular mental health wellness
Access to physical exercise was the most common checks, similar to mandated annual physical wellness
response; free (or discounted) gym memberships, exercise checks. Participants felt that these checks could be an
equipment at the station house, or opportunities for introduction to services for those who are reluctant to
exercise with colleagues (running, hiking) were all offered take those first steps on their own. The mandatory
as ways that first responders could care for their physical, nature of these wellness checks was noted as a critical
and by extension their mental health. Nutrition element; stigma is lessened if all staff are required to
counseling was also mentioned as a service that could attend. Most respondents favored annual checks, though
help bolster mental health. several advocated for semi-annual or quarterly
appointments, or sessions after each critical incident.
Peer support programs were also frequently cited, with
many respondents expressing that peer-led programming, Several first responders thought it important to include
whether a workshop or peer support and counseling, is family in training and/or counseling. They are an
“likely to be more impactful” than “expert-led” programs important source of support, or stress if they are not
and is the best way to guarantee culturally competent supportive or if they cannot understand what their
services. Another respondent reflected on the value partner is experiencing.
of local and regional or statewide peer support.
Finally, several first responders mentioned the value of
“Peer programs can go either way—either you want building camaraderie within departments. This included
to talk to a knowledgeable peer who knows your organized activities, such as hikes or nights out, for
department and the culture of your city and where department members, sometimes even with family
you work or you want to talk to someone very invited. One respondent spoke fondly of the regular
removed from your daily work.” community events convened by her department—a
community walk or clean-up, or a trip to a local baseball
game—all intended to build relationships among
department members and between the department and
the community.

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 TABLE 15
NYS First Responders, programming to address mental health challenges, total and by subgroup

Coping with Awareness of Addressing Addressing

Stress Understanding
anxiety or mental health Mindfulness alcohol and issues of
management stigma
depression challenges drug abuse suicide

All Cases 68% 62% 61% 54% 48% 42% 41%

OCCUPATION

Law enforcement 73% 67% 64% 58% 54% 46% 46%

EMS 70% 64% 63% 55% 49% 45% 44%

Fire 65% 59% 61% 52% 44% 41% 39%

Emergency communications 75% 70% 65% 61% 57% 43% 45%

Emergency manager 76% 70% 64% 61% 54% 40% 45%

Administrative 72% 69% 70% 60% 56% 47% 49%

Other 69% 68% 66% 50% 57% 35% 40%

35 x
TYPE OF SERVICE

Career (paid) 72% 65% 61% 55% 52% 45% 44%

Volunteer 62% 57% 62% 51% 41% 36% 36%

LENGTH OF SERVICE

Fewer than 5 years 59% 53% 53% 45% 42% 35% 37%

5–9 years 68% 60% 59% 53% 51% 41% 42%

10–19 years 69% 64% 60% 54% 50% 42% 41%

20–29 years 74% 69% 67% 58% 51% 47% 44%

30+ years 69% 63% 69% 57% 45% 41% 42%

Question wording: Please indicate which topics would help address some of the mental health challenges faced by first responders, if offered as trainings, seminars, or educational programming, (Check all that apply): (3)
Stress management, (5) Coping with anxiety or depression, (1) Awareness about mental health issues and challenges, (2) Understanding the stigma surrounding mental health challenges, (7) Mindfulness, (4) Addressing
alcohol and drug abuse, (6) Addressing issues of suicide.

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TABLE 16
NYS First Responders, services that would improve first responder mental health if accessible and free,
total and by subgroup

Peer support Couples/

Individual therapy Wellness activities
programs family therapy

All Cases 97% 93% 91% 87%

OCCUPATION

Law enforcement 97% 92% 93% 90%

EMS 97% 92% 89% 87%

Fire 96% 92% 90% 86%

Emergency communications 99% 95% 90% 90%

Emergency manager 100% 97% 94% 90%

Administrative 99% 97% 93% 88%

Other 91% 98% 91% 93%

TYPE OF SERVICE

Career (paid) 97% 93% 92% 90%

Volunteer 95% 91% 86% 84%

LENGTH OF SERVICE

Fewer than 5 years 96% 91% 89% 87%

5–9 years 97% 92% 91% 89%

10–19 years 97% 93% 93% 91%

20–29 years 96% 92% 91% 87%

30+ years 95% 92% 85% 84%

Question wording: Please rate the degree to which the following services, if accessible and free, would help improve first responder mental health, (Scale: not at all,
somewhat, moderately, to a great extent): (1) Individual therapy, (3) Peer support programs, (2) Couples/family therapy, (4) Wellness activities (yoga, mindfulness training,
guided meditation, etc.) Percentages reported here are for total responding somewhat, moderately, to a great extent.

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V. Discussion
First responders in New York, as elsewhere, are struggling first responders, particularly those related to duty
with mental health challenges. They face multiple assignment and job security.
stressors, endure a range of mental health challenges • O
 verall, first responders in the middle of their career
and conditions, and confront barriers to seeking, and appear to face the most challenges. Those with fewer
receiving, mental health care. The MHNA revealed than five years in a first responder role had
several important dynamics: experienced fewer, or had not yet accumulated, the
stress and trauma of first responder work. Further,
• The majority of first responders report significant many respondents suggested that the younger
stressors, mental health challenges, and obstacles to generations are more open to addressing, and
accessing support. These issues are prevalent across all discussing, mental health issues. At the other end of
groups, though some variation by occupation, service the spectrum, those with many years on the job were
type, and service length could offer useful insights for reflective about their experiences and were looking
targeted interventions. Overall, the primary takeaway towards retirement. Those in the middle were still in
is clear: many first responders face considerable mental the throes of the work.
health challenges as a result of their work.
• S tigma remains a substantial barrier to seeking care.
• W
 hile rates are high for all, emergency First responders were concerned that seeking care
communications personnel had among the highest would make them “look weak” and that leadership
ratings for stressors and mental health impacts. Focus and their colleagues would treat them differently and
group participants attributed this to several factors. assume they are unreliable or “not up to the job,”
Explaining the high stress of the emergency particularly in a dangerous situation. This sentiment
communications environment, one respondent stated, may be shifting, however; several respondents
“[we are] hypervigilant, there is no time to come back acknowledged that recent attention to the issue of
down between calls, it’s urgency all the time.” mental health seemed to be lessening this stigma,
Another described the feeling of “cortisol rising with and that younger generations appear to be more
every call” over the course of a shift that could last comfortable with, and open about, acknowledging
anywhere from 8-16 hours. Other respondents and addressing issues of mental health.
emphasized the lack of closure, stating that emergency
communications personnel are often “left out of crisis Relatedly, a fear of consequences, from a light-duty
debriefing” and in many instances, are not made assignment to fear of losing their job altogether,
aware of the outcome of a case. Others felt that prevented first responders from seeking mental health
emergency communications gets sidelined, often care. Other consequences, such as loss of pistol license,
a forgotten part of the first responder lifeline. also kept first responders from seeking care. Many first
Finally, one participant noted that, “Emergency responders asked for clarity about job-related, and
communications does a lot more than just dispatch to other, consequences for seeking mental health care
an incident. For example, we talk people through CPR (including medication).
or other intervention while waiting for an ambulance • L
 eadership at all levels plays a crucial role in creating
to arrive.” Taken together, these factors contribute to a cultures that support, or harm, the mental health of
highly stressful work environment that, some felt, first responders. Relatedly, leadership is key to the
lacks adequate closure, camaraderie, and supports. successful development, implementation, and
• In general, career first responders reported greater reception of mental health initiatives and services
stressors and mental health challenges than within the first responder community.
volunteers though rates were high for all. Barriers to • M
 ental health providers with very particular experience
seeking care were also felt more strongly by career in, or deep knowledge of, first responders’ work,

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experience, and culture are most trusted to provide care. • M

 andatory annual, or more frequent, mental health
There is currently a dearth of these providers. wellness checks.
• Conversations and proactive wellness activities and
In addition, some promising ideas surfaced from the programming to keep mental health in the forefront
MHNA: and to continue to whittle away at the stigma.

• D
 evelopment of a statewide or regional peer support • D
 evelopment of more peer support at the state and
network, trained to address first responder issues local level, with attention to proper training
and available 24/7. This team would be the first line and confidentiality.
of support for struggling first responders and would, • A
 ccess to free or reduced-cost wellness activities, such
when appropriate, refer clients to a professional who as gym memberships, department-wide events, and
had already been vetted for experience, availability, collegial activities that connect first responders to their
and insurance (including tele-mental health). peers and the community.
Confidentiality of this peer support network (and • P
 olicy-level discussions, and introduction of legislation
other peer support programs) is an important issue where appropriate, about ways to mitigate stress
that needs to be attended to in this model. in work environments (e.g., long hours, overtime,
• D
 evelopment of a cadre of culturally competent training for leadership) and increase access to mental
therapists, through the creation of a first responder- health care (e.g., reduced co-pays, discounted services,
focused certificate or micro-credential that can be paid time to seek care).
taken as part of graduate mental health counseling
programs. Participants could receive first responder-
specific training at training centers or through ride-
alongs with first responders.

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VI. Conclusion
Over 6,000 first responders in NYS felt strongly enough about issues of mental health to respond to the
MHNA. There is clearly a need, and first responders want to be heard and helped.

Many MHNA respondents expressed gratitude There was also a fair amount of skepticism
for the needs assessment: that the MHNA would yield tangible results:
“Thank you for taking the time to try and “The survey is great, but [is] this survey really
understand [that] we in the public service going to help change the culture…?”
community need mental health help.” “This is a waste. Nothing will ever be done to
“Thank you for addressing this issue. It has assist [first] responders with mental health.”
been minimized for far too long.” “I think this is just a check in the box for you…
“Thank you for doing a study on this topic. It I believe much of this is “feel good” politics.”
is an area that needs to be improved upon in “Good to collect the information, now what?
our fields of work, and I hope to see it better Surveys get done and nothing changes.
embraced in the future. Thank you.” Do something with it.”
“THIS TOPIC IS SO IMPORTANT!! Thank
you for addressing this. I look forward to seeing
what progresses out of this. This survey is a very
good start to opening people up to the topic.
Keep talking about it and let’s normalize
seeking self-help! Thanks again!”

The first responder community, including leadership at the local and state levels, has a unique opportunity
to harness the current momentum around this crucial issue. The Mental Health Needs Assessment is just
one step toward clearer understanding the depth of need and potential ways to help. Developing and
implementing effective programs and services with real impact will require collaboration among state and
local leaders. Working together, leadership at the state and local level can ensure that their collective efforts
demonstrate commitment to addressing this important issue and ultimately, lead to improvements in first
responder mental health.

39 x New York State First Responder Mental Health Needs Assessment

THE BENJAMIN CENTER

Endnotes
1
NYS Empire State Development, https://esd.ny.gov/regions
2
The survey instrument can be found in Appendix A.
3
NYS Empire State Development, https://esd.ny.gov/regions
4
R
 esults from the survey using weighted data are very similar to results using unweighted data. Additional information about sample weights are
available upon request.
5
E
 stimated total population sizes are drawn from US Census, PUMS ACS 5-Year Estimates Public Use Microdata Sample 2021, as well as
data provided about volunteers by NYS Volunteer Ambulance and Rescue Association and the Firefighters Association of the State of New
York (FASNY). New York City is under-represented and EMS and emergency communications are overrepresented in the sample (as are
emergency managers, to a lesser degree).
6
A
 presentation of the MHNA given in spring/summer 2024 reported on mental health challenges within the first responder field. Outcomes:
stress (94 percent), burnout (90 percent), anxiety (87 percent), PTSD (83 percent), depression (82 percent), substance abuse (68 percent),
and suicidal ideation/suicide (65 percent). Full table and narrative can be found in Appendix B.
7
Appendix C provides greater detail about the degree to which first responders report ever having experienced these mental health symptoms
as a result of their first responder work.
8
C
 omposite measures created from the following: Have you ever experienced any of the following symptoms as a result of your first responder
work? PTSD: Flashbacks, recurring dreams, or spontaneous memories of a disturbing event/events; avoiding reminders of a disturbing event/
events; diminished interest or pleasure in daily activities; persistent and distorted sense of blame of self or others for a disturbing event;
estrangement from friends, family, colleagues; inability to remember key aspects of a disturbing event/events; aggressive, reckless, or self-
destructive behavior; sleep disturbance; hypervigilance. Depression: Persistent feelings of sadness and hopelessness; diminished interest or
pleasure in daily activities. Anxiety: Excessive, persistent, and uncontrollable worry and apprehension.
9
Internal consistency of the PTSD and depression indices was estimated using Chronbach’s Alpha; .854 for PTSD and .736 for depression,
giving high confidence in these indices.
10
Data for the NYS population are drawn from SAMHSA National Survey on Drug Use and Health: Model-Based Prevalence Estimates,
SAMHSA. The SAMHSA National Survey on Drug use and Health asks if respondents had had thoughts of suicide in the past 12 months.
The MHNA asked participants if they had ever experienced thoughts of suicide as a result of their first responder work. Given the incongruity
between the MHNA and the SAMHSA question (career prevalence vs 12 months), the research team averaged the SAMHSA estimate
over an eight-year period to arrive at 4 percent. The eight-year average includes 2008–9 and 2013–2019, 2021–22. The years 2019–20
and 2020–21 are excluded, as data were not collected because of COVID. Rates range from a low of 3.63 in 2017–18 to a high of 4.29 in
2021–22. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
11
Appendix D provides greater detail about the degree to which first responders report these issues as barriers to seeking mental health care.

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APPENDIX A

FIRST RESPONDER
MENTAL HEALTH NEEDS
ASSESSMENT SURVEY
APPENDIX A

1. Please indicate your area of first responder work. 7. What is the annual yearly call volume in your
Check all that apply department, if known (approximate)?
• Law enforcement officer: sworn
• Law enforcement officer: civilian 8. A
 re there adequate systems in place to address first
• Emergency medical services (emergency medical responder mental health needs?
technician, paramedic) Scale: Not at all adequate, not adequate, adequate,
• Fire service very adequate
• Emergency communications official/
Emergency call taker 9. Have any of the following aspects of your first
• Emergency manager responder work ever caused you distress?
• Administrative Check all that apply
• Other: please specify • Shift work
• Over-time
2. Is your first responder position • Risk of being injured on the job
• Supervision/management, with field response duties • Paperwork
• Supervision/management, without field response • Not enough time to spend with friends and family
duties • Lack of understanding from family and friends about
• Not supervision/management (front-line responder) your work
• Public perception of the profession
3. Is your primary position: • Limitations to your social life (e.g. who your friends
Check one are, where you socialize)
• Career (paid) • Traumatic events (i.e. motor vehicle accident,
• Volunteer domestics, injury or death from a shooting).
• Situations encountered on the job (e.g. domestic
4. H
 ow long have you worked in this first responder field? violence, overdose)
Fewer than 5, 5 – 9, 10 – 19, 20 – 29, 30+ • Difficulty with colleagues

5. In what region of the state are you a first-responder? 10. H

 ave you ever experienced any of the following as a
• Western New York (Counties: Niagara, Erie, result of first responder work-related distress?
Chautauqua, Cattaraugus, Allegany) Check all that apply
• Finger Lakes (Counties: Orleans, Genesee, • Burnout
Wyoming, Monroe, Livingston, Wayne, Ontario, • Anxiety
Yates, Seneca) • General stress
• Central New York (Counties: Oswego, Cayuga, • Post-Traumatic Stress Disorder (PTSD)
Onondaga, Cortland, Madison) • Depression
• Southern Tier (Counties: Steuben, Schuyler, • Substance abuse
Chemung, Tompkins, Tioga, Broome, Chenango, • Prefer not to answer
Delaware)
• North Country (Counties: Jefferson, Lewis, St. 11. Please indicate whether first responder work-related
Lawrence, Franklin, Clinton, Essex, Hamilton) distress has ever negatively impacted the following
• Mohawk Valley (Counties: Oneida, Herkimer, areas of your life.
Otsego, Fulton, Montgomery, Schoharie) Scale: Not at all, somewhat, moderately, a great deal,
• Capital Region (Counties: Warren, Saratoga, prefer not to answer
Schenectady, Albany, Greene, Washington, • Home life
Rensselaer, Columbia) • Family relationships
• Mid-Hudson (Counties: Sullivan, Orange, Rockland, • Friendships
Ulster, Dutchess, Putnam, Westchester) • Social life
• Long Island (Counties: Nassau, Suffolk) • Physical health
• New York City (Counties/Boroughs: Bronx, Queens,
New York/Manhattan, Kings/Brooklyn, Richmond/
Staten Island)

 haracteristics of jurisdiction: urban outside of NYC,

6. C
rural, suburban, New York City

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APPENDIX A

12. T
 hinking about the first responder field as a whole, 14. Following are issues that might prevent first
please rate the degree to which you think the responders from seeking care for work-related
following are significant challenges. distress or mental health challenges. Please rate the
Scale: Not significant, somewhat significant, degree to which you think each statement is a barrier
significant, extremely significant to seeking mental health care for first responders
• Post Traumatic Stress Disorder (PTSD) generally.
• Depression Scale, for each: not a barrier, somewhat of a barrier,
• Anxiety moderate barrier, strong barrier, prefer not to answer
• Suicidal ideation/suicide • Not knowing where to get help
• Stress • Not recognizing the need for care
• Substance abuse • Stigma associated with seeking care for mental
• Burnout health issues
• Lack of access to healthcare • Scheduling concerns
• Lack of access to mental health care • Too expensive
• Toxic work culture • Not enough time
• Personal safety • Lack of employer support
• Lack of family support
13. Have you ever experienced any of the following • Lack of community support
symptoms as a result of your first responder work. • Lack of mental health providers who understand the
Scale: never, rarely, occasionally, very frequently, needs of first responders
prefer not to answer • Other (please specify)
• Persistent feelings of sadness and hopelessness
• Diminished interest or pleasure in daily activities 15. T
 he following statements are stigma-related concerns
•E  xcessive, persistent, and uncontrollable worry and that might prevent first responders from seeking care
apprehension for work-related distress or mental health challenges.
• Flashbacks, recurring dreams, or spontaneous Please rate the degree to which you think each
memories of a disturbing event/events statement is a barrier to seeking mental health care
• Avoiding reminders of a disturbing event/events for the first responder community generally.
•P  ersistent and distorted sense of blame of self or Scale, for each: not a barrier, somewhat of a barrier,
others for a disturbing event moderate barrier, strong barrier, prefer not to answer/
• Estrangement from friends, family, colleagues not applicable
• Inability to remember key aspects of a disturbing • Concern that peers will think less of them
event/events • Concern that peers will think they are unreliable in a
• Aggressive, reckless, or self-destructive behavior stressful or dangerous situation (that they’re not “up
• Sleep disturbance to the job”)
• Hypervigilance • Concern that others will think they are weak
• Thoughts about self-harm • Concern that they would be humiliated if others
• Thoughts about suicide found out they were receiving treatment
• Concerns about confidentiality
• Concerns about negative career impact
• Concern that their unit leadership would treat them
differently
• Concern about losing pistol license
• Concern about losing service weapon
• Concern about losing security clearance

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APPENDIX A

16. Please rate the degree to which you think each 21. H ow confident are you in your ability to:
statement is a barrier to seeking mental health care Scale: not at all confident, somewhat confident,
for yourself. confident, very confident, prefer not to answer
Scale, for each: not a barrier, somewhat of a barrier, • Recognize signs/symptoms of distress in your
moderate barrier, strong barrier, prefer not to answer/ colleagues
not applicable • Provide emotional support or assistance to
• Concern that peers will think less of you colleagues who are experiencing distress
•C  oncern that peers will think you are unreliable in a • Help a colleague find appropriate support
stressful or dangerous situation (that you’re not “up
to the job”) 22. H
 ow confident are you in your ability to recognize
• Concern that others will think you are weak signs/symptoms of distress in yourself?
•C  oncern that you would be humiliated if others found Scale: not at all confident, somewhat confident,
out you were receiving treatment confident, very confident, prefer not to answer
• Concerns about confidentiality
• Concerns about negative career impact 23. What is your age:
•C  oncern that your unit leadership would treat you • 18–24
differently • 25–34
• Concern about losing pistol license • 35–44
• Concern about losing service weapon • 45–54
• Concern about losing security clearance • 55–64
• 65+
17. P
 lease indicate which topics would help address
some of the mental health challenges faced by first 24. Select your gender: M, F, other (text)
responders, if offered as trainings, seminars, or
educational programming. 25. What is your race?
Check all that apply • American Indian or Alaska Native
•A wareness about mental health issues and • Asian, Black or African American
challenges • Native Hawaiian or Other Pacific Islander
•U nderstanding the stigma surrounding mental health • White
challenges • Multi-racial
• Stress management • Other with text
• Addressing alcohol and drug abuse
• Coping with anxiety or depression 26. Are you of Hispanic, Latino, or Spanish origin?
• Addressing issues of suicide • Yes/No
• Mindfulness
27. Is there anything else you would like to tell us about
18. Are there topics not listed above that you think would this topic or about the survey itself?
be helpful? (please specify)

19. Please rate the degree to which the following Thank you for your time. If you feel the need for
services, if accessible and free, would help improve assistance, you may contact the organizations or help:
first responder mental health. Disaster Distress Helpline at 1-800-985-5990 or the
Scale: not at all, somewhat, moderately, to a great Crisis & Suicide Lifeline at 988.
extent
• Individual therapy
• Couples/family therapy
• Peer support programs
• Wellness activities (yoga, mindfulness training,
guided meditation, etc.)

20. A
 re there any successful services or best practices
not listed above that you would like to tell us about?
(please specify)

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APPENDIX B

MENTAL HEALTH CHALLENGES,

FIELD AS A WHOLE
APPENDIX B

When asked about the mental health challenges faced by the first responder field as a whole, survey
respondents cited stress most frequently (94 percent) followed closely by burnout (90 percent), and anxiety
(87 percent) (Table 1). Approximately 80 percent of first responders identified depression and PTSD as major
issues. Approximately two-thirds of first responders reported substance abuse (68 percent) and suicidal
ideation (65 percent) as challenges for the field. Career first responders identified these challenges also at
high rates and more frequently than volunteers. Overall, mid-career personnel were more likely to identify
these challenges for the first responder field compared to those with fewer (fewer than 5) and more (more
than 30) years of service, though outcomes are high for all.

TABLE 1
NYS First Responders, mental health challenges for the field, total and by subgroup

Suicide/
Substance
Stress Burnout Anxiety PTSD Depression Suicidal
abuse
ideation

ALL CASES 94% 90% 87% 83% 82% 68% 65%

OCCUPATION

Law Enforcement 98% 93% 91% 87% 88% 73% 74%

EMS 96% 92% 89% 84% 84% 70% 70%

Fire 92% 87% 84% 81% 78% 64% 59%

Emergency
99% 96% 92% 86% 93% 73% 74%
communications
Emergency
97% 95% 91% 84% 86% 71% 67%
manager
Administrative 96% 95% 90% 84% 88% 73% 70%

Other 91% 79% 83% 72% 73% 57% 66%

TYPE OF SERVICE

Career (paid) 97% 94% 91% 86% 87% 74% 70%

Volunteer 90% 83% 82% 78% 75% 57% 56%

LENGTH OF SERVICE
Fewer than
90% 82% 83% 73% 74% 58% 58%
5 years
5–9 years 94% 93% 88% 78% 84% 67% 65%

10–19 years 96% 94% 89% 86% 85% 73% 70%

20–29 years 97% 92% 91% 89% 86% 74% 69%

30+ years 93% 88% 86% 86% 82% 63% 60%

Question wording: Thinking about the first responder field as a whole, please rate the degree to which you think the following are significant challenges: (5) Stress, (7)
Burnout, (3) Anxiety, (1) Post-Traumatic Stress Disorder (PTSD), (2) Depression, (6) Substance abuse, (4) Suicidal ideation/suicide. Percentages reported here are for total
responding somewhat significant, significant, extremely significant.

New York State First Responder Mental Health Needs Assessment 47 x

APPENDIX B

Table 2 presents a more nuanced picture of mental health challenges within the first responder field, as
reported by MHNA respondents. Approximately 4 in 10 first responders identified stress and burnout as
extremely significant challenges in their field, while half that number (approximately 2 in 10) highlight PTSD,
depression, and anxiety as extremely significant issues. Suicidal ideation/suicide and substance abuse were
reported less frequently as extremely significant, at 17 percent and 15 percent respectively. Overall, the
data indicate that the majority of first responders perceive these mental health challenges to be significant–
extremely significant for their field (suicidal ideation and substance abuse are a bit lower at approximately
40 percent).

TABLE 2
NYS First Responders, mental health challenges for the field

Somewhat Extremely
Not significant Significant
significant significant

Stress 6% 20% 35% 39%

Burnout 10% 20% 33% 38%

Post Traumatic Stress Disorder (PTSD) 17% 26% 35% 22%

Depression 18% 27% 35% 20%

Anxiety 13% 28% 37% 22%

Suicidal ideation/suicide 35% 26% 22% 17%

Substance abuse 32% 27% 26% 15%

Question wording: Thinking about the first responder field as a whole, please rate the degree to which you think the following are significant challenges (5) Stress, (7)
Burnout, (1) Post Traumatic Stress Disorder (PTSD), (2) Depression, (3) Anxiety, (4) Suicidal ideation/suicide, (6) Substance abuse.

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APPENDIX C

MENTAL HEALTH SYMPTOMS

APPENDIX C

Table 1 provides greater detail about the degree to which first responders have ever experienced certain
mental health symptoms as a result of their first responder work. Approximately 4 in 10 first responders
reported having experienced sleep disturbance (42 percent) and hypervigilance (36 percent) frequently—
very frequently. Approximately one-quarter of respondents cited frequent—very frequent experiences
of diminished interest in daily activities (26 percent), and uncontrollable worry (24 percent), and 1 in
5 have experienced frequent—very frequent flashbacks (20 percent), persistent feelings of sadness
and hopelessness (18 percent), and estrangement (17 percent). Aggressive behavior was experienced
frequently—very frequently by approximately 1 in 10 first responders (11 percent). Thoughts of suicide were
experienced frequently— very frequently by four percent of respondents. While this percentage may seem
small, it translates to 240 first responders in our sample.

TABLE 1
NYS First Responders, experience of mental health symptoms

Very frequently Frequently Occasionally Never

Sleep disturbance 23% 19% 37% 21%

Hypervigilance 20% 16% 27% 35%

Diminished interest
11% 15% 41% 34%
in daily activities
Uncontrollable worry
11% 13% 33% 44%
and apprehension

Flashbacks 9% 11% 43% 37%

Persistent feelings of sadness

8% 10% 39% 44%
and hopelessness

Estrangement 6% 11% 35% 48%

Aggressive,
4% 7% 24% 65%
reckless behavior

Thoughts about suicide 2% 2% 12% 84%

Question wording: Have you ever experienced any of the following symptoms as a result of your first responder work, (Scale: never, occasionally, frequently, very frequently,
prefer not to answer): (10) Sleep disturbance; (2) Diminished interest or pleasure in daily activities; (11) Hypervigilance; (4) Flashbacks, recurring dreams, or spontaneous
memories of a disturbing event/events; (3) Excessive, persistent, and uncontrollable worry and apprehension; (1) Persistent feelings of sadness and hopelessness; (7)
Estrangement from friends, family, colleagues; (9) Aggressive, reckless, or self-destructive behavior; (13) Thoughts about suicide.

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APPENDIX D

BARRIERS TO SEEKING
MENTAL HEALTH CARE
APPENDIX D

Table 1 provides detail about the barriers to seeking mental health care within the first responder field. All
barrier types—social, potential consequences, logistical, and support-related—are combined into one table.
Social barriers and potential consequences, along with support-related barriers not recognizing the need for
care and lack of culturally competent providers, were the most pressing; more than one-third of respondents
noted these as strong barriers for the field. Logistical issues were cited as strong barriers by approximately
one-quarter to one-third of respondents. Lack of community and family support, and not knowing where to
get help are viewed as lessor constraints, with approximately 10–20 percent of respondents claiming them as
strong barriers.
TABLE 1
NYS First Responders, barriers to seeking mental health care

Somewhat of
Strong barrier Moderate barrier Not a barrier
a barrier

SOCIAL BARRIERS

Stigma 46% 18% 16% 20%

Concern that peers will think they
38% 18% 22% 22%
are unreliable/not “up to the job”
Concern about confidentiality 36% 17% 19% 27%

POTENTIAL CONSEQUENCES

Concern about losing pistol license 45% 12% 11% 32%

Concerns about
39% 17% 18% 26%
negative career impact
Concern that unit leadership
35% 19% 20% 25%
will treat them differently
LOGISTICAL BARRIERS

Time 32% 21% 24% 22%

Scheduling 23% 22% 26% 28%

Expense 29% 17% 19% 35%

Lack of employer support 28% 18% 19% 35%

SUPPORT-RELATED BARRIERS

Not recognizing the need for care 33% 22% 23% 22%
Lack of culturally
35% 19% 21% 25%
competent providers
Not knowing where to get help 21% 22% 26% 31%

Lack of community support 18% 16% 24% 42%

Lack of family support 9% 13% 23% 55%

Following are issues that might prevent first responders from seeking care for work-related distress or mental health challenges. Please rate the degree to which you think
each statement is a barrier to seeking mental health care for the first responder community generally. (1) Not knowing where to get help, (2) Not recognizing the need for
care, (3) Stigma associated with seeking care for mental health issues, (4) Scheduling concerns, (5) Too expensive, (6) Not enough time, (7) Lack of employer support, (8)
Lack of family support, (9) Lack of community support, (10) Lack of mental health providers who understand the needs of first responders. The following statements are
stigma-related concerns that might prevent first responders from seeking care for work-related distress or mental health challenges. Please rate the degree to which you
think each statement is a barrier to seeking mental health care for the first responder community generally. (2) Concern that peers will think they are unreliable in a stressful
or dangerous situation (that they’re not “up to the job”), (5) Concerns about confidentiality, (6) Concerns about negative career impact, (7) Concern that their unit leadership
would treat them differently, (8) Concern about losing pistol license.

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AUTHOR BIOS
Robin Jacobowitz, Ph.D., is the Director of Education Amy Nitza, Ph.D., is the executive director of the
Projects at the Benjamin Center for Public Policy Institute for Disaster Mental Health at SUNY New Paltz,
Initiatives at SUNY New Paltz. Her expertise is in where she also directs the Advanced Certificate in Trauma
evaluation and research. Dr. Jacobowitz served as and Disaster Mental Health. She is a psychologist who
principal investigator of the inaugural First Responder specializes in providing mental health training nationally
Mental Health Needs Assessment, in consultation with and internationally. As a Fulbright Scholar at the
the Institute for Disaster Mental Health and the NYS University of Botswana, she trained mental health and
Division of Homeland Security and Emergency Services. school counselors in the use of group interventions in
Other research efforts have focused in the areas of public HIV/AIDS prevention. She also collaborated with
education and mental health, including work in education UNICEF USA to develop and implement a program of
reform (specifically NYS’ grades 3–8 testing program), mental health support for children and teachers impacted
teacher professional development, workforce development, by the recent disasters in Puerto Rico. She directs
the opioid crisis, and youth disaster mental health. She numerous grant-funded projects including from the New
has authored numerous publications, including most York State Office of Mental Health, Office of Victim
recently Early Career Leadership Institute: Program Services and Division of Homeland Security and
Evaluation, and is the co-author of Stress, Resilience, and Emergency Services. Amy has provided training at the
Psychological First Aid for Buffalo: An Exercise in federal level to the Executive Office of the President, the
Cultural Humility. Federal Bureau of Investigation and the Smithsonian
Institution. She has provided direct service to survivors of
Prior to SUNY New Paltz, Dr. Jacobowitz worked at numerous disasters including Hurricanes Sally, Dorian,
New York University’s Institute for Education and Social Harvey, and Maria, the Creek Fire in California, and the
Policy and University of Chicago’s Chapin Hall Center earthquakes in Haiti and Puerto Rico. She is the author
for Children. Bridging her professional expertise to of numerous publications, including the book Disaster
community service, Robin served on the Kingston City Mental Health Case Studies: Lessons Learned from
School District Board of Education for thirteen years Counseling in Chaos.
(2011–2024). She holds an MEd in education policy from
the Harvard University Graduate School of Education
and a Ph.D. from the Robert F. Wagner Graduate School
of Public Service at NYU.

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Kathleen (kt) Tobin, Ph.D., is the Director of the Jesse Hazard is a Program Research Specialist for the
Benjamin Center for Public Policy Initiatives at SUNY New York State Office of Temporary and Disability
New Paltz. She is responsible for designing, managing, Assistance. She graduated summa cum laude from
and publishing studies focused on regional and statewide SUNY New Paltz in 2024 with a degree in Political
issues. She is a graduate of SUNY New Paltz (Sociology, Science. While at SUNY New Paltz, Jesse was awarded
’92), holds an M.S. in Social Research from CUNY the prestigious Cetrino Scholarship through the
Hunter, and a Ph.D. in Sociology from SUNY Albany. Benjamin Center for Public Policy Initiatives. As a
Before returning to her alma mater SUNY New Paltz in Cetrino Scholar, Ms. Hazard was integral in helping to
2008, Dr. Tobin led survey research projects at the Marist conduct the First Responder Mental Health Needs
Institute for Public Opinion (1997–2008).   Assessment. She also contributed to research on
countywide opioid and substance abuse prevention
Dr. Tobin provided research and editorial support for programs and education reform initiatives in New York
the inaugural First Responder Mental Health Needs State. Ms. Hazard is a member of Pi Sigma Alpha, the
Assessment. She is an applied social researcher with national political science honor society, and earned first
methodological expertise in survey methods and place in the “21st Annual Pi Sigma Alpha Best Student
experience in emergency preparedness. Dr. Tobin served Paper Essay Contest.”
on the New Paltz School Board (2009–2012) and is a
former Deputy Mayor of the Village of New Paltz
(2017–2021). She was Public Information Officer for
New Paltz Emergency Preparedness for over a decade
(2011–2022). With the goal of informing public policy,
she has conducted several NYS surveys of public officials
including during the pandemic when she directed a
survey of local elected leaders across the state about
how they and their communities were handling the
COVID-19 crisis.

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ACKNOWLEDGEMENTS
Governor Kathy Hochul and Commissioner Jackie Bray of the NYS Division of Homeland Security and
Emergency Services (DHSES) provided foundational support for the NYS First Responder Mental Health
Needs Assessment. Their vision and support helped initiate this work.

DHSES provided funding for the research. Within DHSES, Terry Hastings, Senior Policy Advisor, Luci
Labriola-Cuffe, Deputy State Fire Administrator, and Julia Marshall, Program Analyst, contributed to many
aspects of the work, including survey development, dissemination of the survey through their extensive
networks, and review of results. We appreciate their thoughtful insights and the time they dedicated to the
Mental Health Needs Assessment. Andrew O’Meara assisted with survey design and provided feedback on
initial results. Nikhil Natarajan lent a first responder eye to many aspects of this work. SUNY New Paltz
undergraduates Morgan Atwater, Abigail Bellos, and Monica Ayres helped with copy edits and proofing.
A big thank you to Colleen Cody, Laura Kniffen, and Carmen Calderon who transformed tables, figures, and
text into an enticing format, and to Jeff Lesperance and student Emily Monroe for helping to design the
survey for distribution.

Finally, we want to express our deep gratitude to the more than 6,000 first responders across New York State
who gave of themselves by responding to our survey; a special thank you to those who gave additionally
through participation in the focus groups. It is not easy to talk about mental health and we very much value
your contributions and perspective. Thank you for sharing your experience with us.

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THE BENJAMIN CENTER FOR PUBLIC POLICY INITIATIVES

Independently and in collaboration with local governments, businesses, and
not-for-profits in the Hudson Valley, The Benjamin Center (formerly CRREO):

•c
 onducts studies on topics of regional and statewide importance;
• brings visibility and focus to these matters;
• fosters communities working together to better serve our citizenry;
•a
 nd advances the public interest in our region.

The Benjamin Center connects our region with the expertise of SUNY New Paltz
faculty. We assist in all aspects of applied research, evaluation, and policy analysis.

newpaltz.edu/benjamincenter

The Benjamin Center for Public Policy Initiatives | State University of New York at New Paltz | 1 Hawk Drive | New Paltz, NY 12561-2443