First Responder Wellness Research

Are Police Attitudes Toward Mental Health Help-Seeking Changing?

For years, research on law enforcement mental health has highlighted stigma, concerns about confidentiality, fear of career consequences, and cultural expectations of toughness as barriers to seeking support.

But could those attitudes be changing?

Hakeos and colleagues examined mental health help-seeking attitudes, intentions, and perceptions of other officers who seek help among 337 sworn, full-time police officers across 22 U.S. states.

The findings offer some encouraging signs.

Officers in this study generally reported:

• Positive attitudes toward seeking professional mental health support

• Greater intentions to seek help when needed

• More positive perceptions of other people who seek mental health treatment

• Predominantly low or moderate levels of psychological distress

Only 3.2% of participants who completed the distress measure were classified in the high-distress group. Female officers showed slightly more positive help-seeking attitudes and intentions and less negative stereotyping than male officers, although the authors caution that the differences may not be clinically meaningful.

One of the most interesting parts of this research is what it suggests about police culture.

The authors discuss whether increased attention to officer mental health, greater education and awareness, leadership support, and the expansion of department-based mental health resources may be contributing to changing attitudes.
But they cannot conclude that these efforts caused the differences they observed.

This was a cross-sectional study, participants self-selected into the research, not everyone completed every measure, and only eight participants were in the high-distress group. It is possible that officers who were more comfortable discussing mental health were also more likely to participate.

Still, there is an encouraging message here:

Police culture is not necessarily static.

Departments can continue working to reduce barriers through leadership support, normalization of mental health services, stigma reduction, confidential and accessible resources, and police-specific mental wellness programs.

We often talk about the barriers preventing first responders from seeking help. It is equally important to study when those attitudes begin moving in a healthier direction and understand what may be helping that change occur.

Reference:
Hakeos, S., Mueller, M., Davidson, T., Thoen, M. A., Nichols, M., & Miller, S. (2025). Police officers’ attitudes, intentions, and stereotyping towards mental health help seeking behaviors. Research Square. Preprint. PubMed
DOI: 10.21203/rs.3.rs-6181234/v3

🚨 Just over ONE WEEK away! 🚨

The 5th Annual Answering the Call Conference is almost here, and I am excited to be returning to Tennessee to speak at this event!

I’ve had the opportunity to attend all five years of this conference, and it continues to be an important gathering of people committed to improving first responder mental health, su***de prevention, and wellness.

I’m looking forward to reconnecting with familiar faces, meeting new people, hearing from other speakers, and sharing some of the research and work I’ve been doing to advance proactive first responder wellness.

📅 October 19–20, 2026

📍 Williamson Family Farms, Murfreesboro, TN

🎟️ Registration: $125

⏰ Registration closes October 13!

CAPCE and POST approved.

🔗 Register at: https://www.TNFirstRespondersFoundation.com

If you’re attending, let me know! I’d love to connect while we’re there.

And if you’ve been thinking about registering, don’t forget that the deadline is coming up!

Understanding Police Culture Is Part of Providing Effective Mental Health Care

Police officers can spend an entire career repeatedly exposed to critical incidents, loss, violence, organizational stress, and situations requiring difficult decisions under pressure.

Yet when an officer eventually walks into a therapist's office, there may already be another challenge waiting:
Does this clinician understand the job?

Papazoglou and Tuttle (2018) examined the psychological needs of police officers and offered practical recommendations for clinicians working with officers experiencing occupational stress and trauma.

One of their central points is that skepticism toward mental health care cannot be separated from the culture of policing.
Officers may worry about stigma, confidentiality, career consequences, being perceived as weak, or working with clinicians who do not understand police culture.

The authors emphasize that effective clinical work requires more than knowing how to treat trauma.

Clinicians working with law enforcement should understand:

• Police culture, language, hierarchy, and occupational identity

• The cumulative nature of operational and organizational stress

• Moral injury, loss, and compassion fatigue

• The transition between the officer role and family
• How stigma and concerns about professional consequences can affect help-seeking

• The importance of building trust before expecting vulnerability

They also recommend practical ways for clinicians to develop that understanding, including learning directly about police work, staying current with research, collaborating with peer-support programs, incorporating families when appropriate, and participating in ride-along programs.

I think this distinction remains incredibly important.

Being trauma-informed does not automatically mean being occupation-informed.

A clinician can be highly skilled in treating PTSD and still struggle to establish an effective therapeutic relationship if the officer feels that they have to spend the session explaining the culture, language, realities, and expectations of the profession.

For first responders, cultural competence is not about a therapist pretending to be one of them. It is about doing enough work to understand the world they operate in so the responder does not have to teach the therapist before the therapy can begin.

This article was published in 2018 and is primarily a clinical and practice-oriented paper drawing on existing research rather than a new empirical study. Still, many of its recommendations remain highly relevant to current conversations about culturally responsive mental health care for first responders.

Access to a therapist is important. Access to a therapist who understands the occupation can be something very different.

📖 Reference:
Papazoglou, K., & Tuttle, B. M. (2018). Fighting police trauma: Practical approaches to addressing psychological needs of officers. SAGE Open, 8(3), 1–11. journals.sagepub.com
DOI: 10.1177/2158244018794794

It is my busy season, and I just want to thank all of you for your engagement, messages, and conversations

We Keep Asking Paramedics to Build Resilience. But What About the System They Work In?

Paramedics work in an environment where trauma exposure, high operational demands, irregular schedules, and shift work can affect both mental well-being and sleep.

Wanstall and colleagues (2026) asked an important question: What interventions have actually been studied to improve these outcomes?

Their scoping review identified 19 sources involving 1,067 participants across seven countries and examined 17 different interventions. More than half of the studies were randomized controlled trials, but researchers used 43 different measurement tools, making the evidence difficult to compare across studies.

The interventions fell into three broad categories:

• 37% psychological interventions

• 32% sleep, fatigue, and/or shift-work interventions

• 32% complementary and alternative medicine approaches

But one number really stands out:

94% of the interventions focused primarily on changing something at the individual level.

That means much of the research has focused on helping the paramedic adapt rather than changing the conditions surrounding the paramedic.

And the evidence is not yet particularly strong. The authors identified limitations involving small samples, study design and quality, limited long-term follow-up, and low baseline symptoms.
Although some sleep-focused interventions were identified, they were rarely designed specifically to improve mental well-being.
This doesn't mean individual interventions aren't valuable.

Sleep education matters.

Coping skills matter.

Resilience training matters.

Mental health treatment matters.

But we also have to ask whether we're addressing the conditions contributing to the problem.

A paramedic can learn better sleep practices, but those practices still have to exist within shift work, operational demands, workplace culture, staffing realities, and organizational policies.
The authors identified a significant gap in robust, evidence-based system-level interventions and called for approaches that are co-designed with paramedics, sensitive to the realities of their work, and integrated into organizational structures.

That may be one of the most important takeaways:

We shouldn't stop teaching first responders how to take care of themselves. But we also shouldn't expect individual first responders to compensate for systems that make wellness difficult to maintain.

The next generation of first responder wellness research needs to examine both.

📖 Reference:
Wanstall, S. E., Brown, B. W., Crowther, M. E., Dunbar, C., Adams, R. J., Naweed, A., & Reynolds, A. C. (2026). Interventions to improve mental well-being and sleep in paramedics: A scoping review. PLOS ONE, 21(3), e0344377.
DOI: 10.1371/journal.pone.0344377

What if the biggest barrier to seeking mental health support isn't the availability of resources, but what people believe will happen if they use them?

For police employees, stigma can influence whether someone feels comfortable reaching out for mental health support.

A 2023 study by Daniel Grupe examined the relationships between mental health stigma, attitudes toward seeking help, and intentions to access support among 259 sworn and civilian police employees in three Midwestern police agencies.

The findings highlight several important considerations:

Perceived public stigma was associated with more negative attitudes toward seeking mental health support.

Self-stigma helped explain the relationship between perceived public stigma and help-seeking attitudes.

More negative help-seeking attitudes were associated with reduced intentions to seek support.

Greater psychological distress was associated with increased stigma and, indirectly, lower future help-seeking intentions.

Previous participation in mindfulness training was associated with reduced perceived stigma and, indirectly, greater intentions to seek support.

One finding deserves particular attention: civilian police employees reported higher levels of perceived stress, anxiety, and depression than sworn personnel.

When discussing law enforcement wellness, we cannot overlook the civilian employees who contribute to public safety.

For agency leaders, this research reinforces the importance of addressing both organizational culture and individual beliefs.

Providing counseling, peer support, or wellness programs is important. But those resources may have limited reach if employees believe that seeking help signals weakness or could negatively affect how others perceive them.

Normalizing conversations about mental health, communicating protections for employees who seek support, and creating opportunities to challenge stigma are important considerations.

The study was cross-sectional, meaning it cannot establish causation or demonstrate that mindfulness training reduces stigma. However, it identifies potentially valuable areas for future intervention research.

Having resources available is one thing. Creating an environment where employees feel comfortable using them is another.

For those working in law enforcement, what has your department done to normalize seeking mental health support?

Reference:

Grupe, D. W. (2023). Mental health stigma and help-seeking intentions in police employees. Journal of Community Safety and Well-Being, 8(Suppl 1), S32–S39.

https://doi.org/10.35502/jcswb.290

First Responder Wellness Should Be a System, Not a Single Resource

When we talk about mental health support in fire and EMS agencies, the conversation often centers on individual resources:

Do we have an EAP?

Do we have peer support?

Do we have a clinician to call after a difficult incident?

But Kristen Wheldon’s chapter on developing a comprehensive fire service psychology program takes a much broader approach.

The chapter outlines how departments and EMS agencies can move from having individual mental health resources to developing an intentional, sustainable behavioral health system.
The framework is rooted in public health and human services principles and emphasizes needs assessment, stakeholder engagement, program planning, measurable goals, and ongoing evaluation.

A comprehensive program can extend well beyond counseling after a difficult call. Wheldon discusses the role of fire service psychology across areas such as:

• Pre-employment psychological screening
• Fitness-for-duty evaluations
• Crisis intervention
• Trauma-informed care
• Behavioral health and wellness services
• Development of culturally competent provider networks
• Administrative and organizational consultation

One piece I particularly appreciate is the emphasis on systems-level planning.

Before building another program, departments need to understand what their people actually need, involve the people who will use and support the program, establish clear goals, and determine how they will know whether the program is working.

The chapter also addresses some of the complexities that can arise when behavioral health becomes embedded within a department, including ethical responsibilities, legal considerations, cultural competence, and potential dual-role conflicts.

That distinction matters.

A comprehensive wellness program isn't simply a collection of services.

It is an intentionally designed system of prevention, assessment, intervention, referral, support, and evaluation that fits the culture and needs of the organization.

For fire and EMS leaders, perhaps the question is no longer simply:

"What mental health resources do we offer?"

A better question may be:

"Do those resources function together as a comprehensive system that our people can trust, access, and sustain?"

This is a book chapter rather than an empirical outcome study, so it should be viewed as a framework for program development and implementation rather than evidence that a particular program model produces specific mental health outcomes.

📖 Wheldon, K. (2026). Developing a comprehensive fire service psychology program within a fire department or EMS agency. In Fire Service Psychology: A Comprehensive Approach to Enhancing Firefighter Health, Safety, and Longevity (pp. 249–269). Springer Nature Switzerland. Springer
Chapter DOI: 10.1007/978-3-032-02126-7_12

Next up is: Danny Jones!
Danny brings years of experience and service to the citizens of our state and country. Danny’s passion for building a strong community among first responders to promote mental wellness is unmatched.

Get your ticket before October 13th, you don’t want to miss this opportunity! And you will receive 10.25 CEUs for this event from POST and CAPCE!
Https://www.tnfirstrespondersfoundation.com/answeringthecall

What Would Make a Mental Health Clinic Actually Work for First Responders?

We often talk about getting first responders into mental health care. But simply making services available doesn't mean people will feel comfortable using them.

Researchers in Ottawa, Canada asked an important question:
What would it take to successfully design and implement a mental health clinic specifically for first responders?

The researchers conducted in-depth qualitative interviews with 14 key stakeholders representing police, fire, paramedicine, unions/associations, and the Workplace Safety and Insurance Board. The interviews explored what a first responder-specific Operational Stress Injury (OSI) clinic would need to look like to actually work.

Four major areas emerged:

• Implementation context: Is there a recognized need, and does the workplace culture support seeking care?

• Clinic design: How will services be delivered? What will confidentiality look like? What will it cost? How will first responders learn about it?

• Implementation: What barriers could prevent the clinic from succeeding, and what factors could help?

• Broader impact: How might creating a specialized service influence first responders and their organizations?

One finding stood out to me:

Confidentiality and cultural competency were considered paramount to first responder uptake. PubMed Central (PMC)
Participants also described the importance of multidisciplinary services, care for first responders and their families, low barriers to entry, minimal wait times, connections with other levels of care, virtual and in-person options, and a clinic located away from environments that first responders associate with their work.

The confidentiality piece deserves particular attention. Participants emphasized that first responders would need confidence that employers could not access their clinical information. The researchers also identified practical considerations as detailed as staggering appointments so first responders would be less likely to encounter coworkers in a waiting room.

That says a lot about what access really means.

We can build a clinic.

We can create an EAP.

We can hand someone a therapist's phone number.

But if the person doesn't trust the system, doesn't believe their information will remain confidential, or doesn't believe the clinician understands their occupation, technically having access may not translate into actually receiving care.

This study also reinforces something I continue to see across first responder research: workplace culture and service design cannot be separated. Participants described culture as capable of either supporting help-seeking or undermining even well-intentioned mental health initiatives.

For those of us working to improve first responder mental health systems, perhaps the question shouldn't only be:
"Do we have mental health resources?"

We also need to ask:
"Have we designed those resources in a way that first responders will trust and use?"

This was a small qualitative study conducted within one Canadian community and focused primarily on stakeholder perspectives about implementation, so the findings should not be treated as evidence that a specialized clinic itself improves mental health outcomes. But it provides valuable insight into what first responder communities believe should be considered when building one.

Citation:
MacLean, S. E., Edgar, N. E., Ahluwalia, C., Testa, V., & Hatcher, S. (2025). A qualitative study on the design and implementation of a first responder operational stress injury clinic. Health Services Insights, 18. PubMed Central (PMC)
DOI: 10.1177/11786329251333019

Sometimes the Hardest Part of the Job Isn't the Call

🚑🚒 We spend a lot of time talking about what first responders see and experience in the field.

But what happens inside the organization matters too.

A study by O’Dare and colleagues examined psychological safety, workplace incivility, institutional betrayal, and mental health among 799 EMS and fire personnel in Florida.

The findings are worth paying attention to.

Among respondents:
• 33.2% screened positive for probable PTSD
• 32.3% reported moderate to severe depressive symptoms
• 27.6% reported moderate or high burnout
• 59.5% reported experiencing at least one form of institutional betrayal DOI

But this study wasn't only about prevalence.

It looked at what was happening in the workplace.

Institutional betrayal was significantly associated with higher PTSD, depression, and burnout and with lower resilience. Among those reporting institutional betrayal, 43.4% met the study's threshold for probable PTSD compared with 18.1% among those who did not report institutional betrayal.

Workplace incivility mattered too.

We're talking about behaviors that can sometimes get dismissed as simply part of the culture: exclusion, sarcasm, dismissive comments, disrespect, or other persistent interpersonal mistreatment.

Greater incivility was associated with higher PTSD, depression, and burnout and lower resilience.

And then there was psychological safety.

Do you feel safe speaking up?

Can you admit a mistake?

Can you ask a question?

Can you say you're struggling?

Can you raise a concern without worrying about what it will cost you professionally?

First responders experiencing mental health concerns reported lower psychological safety across relationships with supervisors, command staff, peers, and teams. Psychological safety was lowest in interactions with command staff overall.

This matters because sometimes we focus so heavily on teaching first responders how to cope with the job that we overlook something important:

The workplace itself can either support recovery or add another layer of stress.

We absolutely need healthy coping skills, peer support, culturally competent clinicians, and accessible mental health resources.
But we also need workplaces where people are treated with respect, leaders can be trusted, concerns can be raised safely, confidentiality is protected, and asking for help doesn't feel like a career risk.

For leaders, this research provides an important reminder:
First responder wellness isn't only about what resources you offer. It's also about the environment people return to after the call.

And culture is something organizations have the ability to change.

Because this was a cross-sectional study, we cannot say these workplace factors caused PTSD, depression, or burnout. What we can say is that the relationships were significant and consistent enough to warrant attention and further longitudinal research.

📖 O’Dare, K., Atwell, L., Porter, L., Carlson-Moore, B., Jiang, J., Jameson, A., & McCoy, S. (2025). Psychological safety, workplace incivility, and institutional betrayal: Organizational factors shaping mental health in first responders. Journal of Community Safety and Well-Being, 10(4), 203–210.
DOI: 10.35502/jcswb.490