We need to care for the front-line workers who care for us

We have increasingly witnessed the mental health toll on those who have chosen these career paths, including significant increased risk for depression, anxiety disorders, and suicide.

Kurt Becker, a paramedic firefighter, urged his union members to seek therapy during the pandemic in Clayton, Mo., on May 3, 2020.WHITNEY CURTIS/NYT

Last month, the Miami-Dade police director’s attempted suicide hammered home the all-too-real mental health crisis facing first responders nationwide.

The attempted suicide came after a series of well-publicized suicides in our fields, such as the death of Dr. Lorna Breen in April 2020, which underscored the risk for suicide among physicians and other health care providers working on the front lines of the COVID-19 pandemic.

With nearly a century of law enforcement and trauma care experience between us, our respective careers have followed paths that often overlapped in the care of victims of gun violence, mental health emergencies, domestic violence, and other challenges to health and safety.

At the same time, we have also had the privilege of working with thousands of law enforcement officers, EMTs, paramedics, doctors, nurses, and other first responders and health care providers whose careers were collectively driven by the desire to make a difference in the safety and well-being of the citizens and community they served.

Conversely, we have also increasingly witnessed the mental health toll on those who have chosen these career paths, including significant increased risk for depression, anxiety disorders, and suicide.

Even before the COVID pandemic, a large review of 60 scientific studies showed physicians were at significantly higher risk for suicide than the general population.

On average, one physician dies by suicide every day in this country. A 2022 survey of health care workers, including nurses, doctors, EMT/paramedics, physician assistants, and nurse practitioners, showed that 93 percent were experiencing stress, 86 percent reported experiencing anxiety, 76 percent reported exhaustion and burnout, and 75 percent said they were overwhelmed. Doctor and nurse burnout may directly affect patients as well, with many of those who reported feeling burnout having recently made a medical error. In addition, nurses are fleeing their profession in high numbers, with burnout cited as the primary reason. Many of those who reported feeling burnout had recently made a medical error.

Likewise, law officers have a high prevalence of post-traumatic stress disorder and a 54 percent increase in suicide risk when compared to the general population. The 2022 Ruderman Family Foundation study found that police officers and firefighters are more likely to die by suicide than working in the line of duty. Four police officers died by suicide within weeks of the Jan. 6, 2021, US Capitol riots.

There is certainly no simple solution. These professions are bonded by inherent risks and challenges: difficult working conditions and long hours; rotating and irregular shifts; risk for exposure to infectious diseases and workplace violence (especially for law enforcement); routine exposure to human suffering and death; and easy access to lethal means such as firearms and medications. Stress cannot simply be removed. But recognition, mitigation, and treatment of mental health duress is also significantly limited by a continued culture of stigma and/or fear of job repercussions if help is sought.

According to The Physicians Foundation’s 2022 Survey of America’s Physicians, nearly 4 in 10 physicians were afraid or knew another physician fearful of seeking mental health care because of questions asked in licensure, credentialing, or insurance applications. Indeed, many state licensing and hospital credentialing applications still ask intrusive mental health questions. Licensure questions are also a major source of mental health stigma among nurses. In addition, despite the prevalence of mental health challenges among police officers, there is still significant stigma attached to seeking help.

An important first start is a paradigm shift to where the culture surrounding first responder and health care workers’ mental health changes from stigma to psychological safety. Stress, anxiety, depression, and even suicidal ideation in these professions should be no surprise and, in fact, are to be expected.

Best practices of primary prevention efforts in the workplace to reduce stress and improve difficult working conditions should be standard. The Dr. Lorna Breen Heroes Foundation, started by her sister and brother-in-law, has strongly pushed for removing intrusive mental health questions from hospital credentialing applications and advocated for other measures to support the mental health and well-being of clinicians. Just as important are training and vigilance for supervisors, colleagues, and ourselves to recognize signs of burnout and depression and to not hesitate to give or seek help. There must be in every organization immediate access to peer support and mental health services that maintain privacy and confidentiality.

The jobs of first responders and health care professionals will never be free of stress. But the risk to their mental health, as well as the risk to the citizens and patients they serve, will be significantly reduced by the continued development of programs and resources aimed at eliminating stigma, identifying warning signs, and offering comprehensive support, counseling, and treatment.

Ed Davis is a former commissioner of the Boston Police Department. Dr. Jonathan Olshaker is a former chair of the Emergency Department of Boston Medical Center and professor emeritus of the Boston University School of Medicine.

Editor’s note: If you or someone you know is considering self-harm or suicide, please call or text the 988 Suicide & Crisis Lifeline at 988. You may also text HOME to 741741 to reach the Crisis Text Line.