First Responder Wellness Research

📢 Seeking Subject Matter Experts for a First Responder Wellness Research Study

I am recruiting qualified professionals to review the newly developed Preventive Resilience & Readiness Assessment Battery (PRR-AB).

The assessment tools are designed to measure:

• Leadership preparedness for workforce wellness
• Perceptions of behavioral health supports
• Organizational wellness climate within first responder agencies

I am seeking professionals with expertise in one or more of the following areas:

• Law enforcement, EMS, fire, communications/dispatch, or corrections leadership
• First responder behavioral health
• Peer support

Participation involves completing an online rating form to evaluate assessment items for relevance and clarity and provide recommendations for improvement. The review takes approximately 30–45 minutes.

Participation is voluntary, and there is no compensation.

To review the study information and participate, send me your email address as a DM for the link

Please share this invitation with other qualified colleagues who may be interested.

Questions may be directed to Joy Hutchinson, Ph.D., at [email protected].

Organizational Culture Can Determine Whether EMS Clinicians Stay or Leave

When agencies struggle with retention, the conversation often focuses on pay, staffing, or burnout.

But a 2025 national study suggests there may be another critical factor:

Organizational culture.

Kamholz and colleagues surveyed more than 30,000 EMS clinicians across the United States to examine whether the type of organizational culture within an EMS agency influenced clinicians' intentions to leave the profession.

The findings were clear.

Not all organizational cultures have the same impact on retention.

Agencies with higher turnover intentions tended to have cultures that were:

📋 Highly hierarchical – rigid structures and formal procedures.

📈 Market-driven – emphasizing competition and results.

🚀 Adhocracy – highly innovative but sometimes lacking stability and consistency.

The culture associated with the lowest likelihood of clinicians wanting to leave?

🤝 Clan Culture

A clan culture is characterized by:

✅ Strong teamwork

✅ Collaboration

✅ Mutual trust

✅ Supportive leadership

✅ Mentorship

✅ A sense of belonging and shared purpose

Rather than functioning like a bureaucracy, these organizations function more like a cohesive team where employees feel valued and connected.

For first responder leaders, this is an important reminder.

Retention isn't only about salary or recruitment.

People are more likely to stay where they feel respected, supported, heard, and connected.

As someone whose research focuses on preventive mental wellness and organizational change, I find these results especially encouraging.

They reinforce that organizational culture is not just a leadership issue—it's a wellness issue, a retention issue, and ultimately a public safety issue.

Building healthier organizations may be one of the most effective strategies we have for strengthening the EMS workforce.

💬 If you could change one aspect of your agency's culture tomorrow, what would it be?

📖 Read the article here:
https://www.mdpi.com/1660-4601/22/5/756

Citation:
Kamholz, J. C., Gage, C. B., van den Bergh, S. L., Logan, L. T., Powell, J. R., & Panchal, A. R. (2025). Association between organizational culture and emergency medical service clinician turnover. International Journal of Environmental Research and Public Health, 22(5), 756. https://doi.org/10.3390/ijerph22050756

Research continues to show that supporting first responder mental health requires more than simply telling people to “reach out.”

In interviews with firefighters, EMS professionals, law enforcement officers, and others involved in first responder mental health initiatives, researchers identified several ongoing needs:

• Mental health and self-care training throughout a first responder’s career
• Clinicians who understand first responder culture and occupational experiences
• Clear confidentiality protections for peer support
• Leaders and internal champions who actively support mental wellness
• Collaboration across departments to share resources and effective practices

The study also found that smaller and rural departments may face greater barriers to developing comprehensive programs. Regional collaboration—essentially creating “mutual aid” for mental health—may help agencies share trained peer supporters, clinicians, policies, and other resources.

First responder mental health cannot depend entirely on individuals asking for help after reaching a crisis point. It must be supported through training, trusted resources, effective policies, culturally responsive care, and organizational commitment.

Read the open-access study:
https://link.springer.com/article/10.1007/s10597-023-01121-1
Download PDF

Fisher, M. P., & Lavender, C. D. (2023). Ensuring optimal mental health programs and policies for first responders: Opportunities and challenges in one U.S. state. Community Mental Health Journal, 59, 1341–1351.

What Keeps First Responders From Asking for Help?

If we want to improve first responder mental health, we have to understand why so many still don't seek care.

Jones, Agud, and McSweeney explored this question by interviewing firefighters and EMS professionals to better understand the barriers—and the facilitators—to seeking mental health care. Their findings continue to resonate across first responder professions today.

The researchers identified five major barriers:

🚫 "I can't show weakness."
A culture that values toughness can make vulnerability feel unsafe.

🔒 Fear of confidentiality breaches.
Many worried their personal struggles would not remain private.

😞 Negative experiences with therapists.
Some participants felt previous clinicians didn't understand first responder culture.

📍 Limited access to appropriate care.
Finding clinicians with relevant experience or available appointments remained challenging.

👨‍👩‍👧 Concern about burdening family members.
Many chose to carry the weight alone rather than worry those they love.

Just as importantly, the study identified what encourages help-seeking:

✅ Realizing "I'm not alone."

🤝 Support and encouragement from peers and trusted leaders.

🧠 Positive experiences with culturally competent therapists.

⚠️ Recognizing when symptoms had become too difficult to manage alone.

💬 Recommendations from trusted colleagues, friends, or family members.

One of the strongest themes running through the study was knowledge.

When first responders lacked knowledge about mental health or available resources, it became a barrier. When they understood mental health, recognized symptoms, and knew where to find appropriate care, that same knowledge became a facilitator for seeking help.

As someone who works in preventive mental wellness, I believe this reinforces an important point:

We don't improve mental health simply by making services available.

We improve it by building cultures where seeking help is expected, protected, and supported by leadership.

Changing culture doesn't happen with one training or one policy.

It happens one conversation, one leader, and one act of support at a time.

💬 Which barrier do you think first responder organizations have made the most progress on—and which still needs the most work?

📖 Read the article here:
Barriers and Facilitators to Seeking Mental Health Care Among First Responders: "Removing the Darkness"

Citation:
Jones, S., Agud, K., & McSweeney, J. (2020). Barriers and facilitators to seeking mental health care among first responders: "Removing the Darkness." Journal of the American Psychiatric Nurses Association, 26(1), 43–54. https://doi.org/10.1177/1078390319871997
Access Options

PTSD Doesn't Just Affect the Mind—It Affects the Body

Most people think of PTSD as nightmares, flashbacks, or anxiety.

But research has consistently shown that PTSD can also have a profound impact on physical health, healthcare utilization, and workplace performance.

A landmark study by Hoge and colleagues (2007) examined Iraq War veterans and found that those with PTSD reported:

🏥 More healthcare visits

🤕 More physical (somatic) symptoms, such as headaches, pain, gastrointestinal issues, and fatigue

📅 More missed work due to illness

Although this study focused on military veterans, the findings are highly relevant to first responders.

Police officers, firefighters, EMS professionals, dispatchers, and corrections officers are also repeatedly exposed to traumatic events throughout their careers. We now know from decades of research that many experience similar patterns of:

🚑 Increased physical health complaints

💊 Higher healthcare utilization

📉 Reduced job performance

🤒 Increased absenteeism

❤️ Greater risk for chronic health conditions

One of the most important lessons from this research is that psychological injuries don't stay confined to mental health—they often become physical health issues as well.

This is one reason why I advocate for preventive mental wellness programs rather than waiting until someone reaches a crisis.

Supporting mental health isn't just about reducing PTSD.

It's about improving overall health, reducing absenteeism, strengthening workforce readiness, and helping first responders remain healthy throughout their careers.

Healthy minds contribute to healthy bodies—and healthy organizations.

💬 Have you seen connections between chronic stress and physical health during your career?

📖 Read the article here:
https://psychiatryonline.org/doi/10.1176/ajp.2007.164.1.150

If you work with first responders—or if you are a first responder committed to improving the health and wellness of your agency—I hope you'll consider joining us for the 2026 Research to Practice Symposium at Oklahoma State University on September 29.

I'll be speaking alongside an outstanding group of researchers and practitioners about advancing first responder resilience through evidence-based, practical approaches. My presentation will focus on preventive mental health, reducing barriers to care, and translating research into strategies that can be implemented within public safety organizations.

This symposium is designed to bridge the gap between research and real-world practice, making it valuable for:
🚔 Law Enforcement
🚒 Fire Service
🚑 EMS
🎧 Dispatch/Communications
🪖 Military & Veterans
🧠 Therapists, counselors, psychologists, social workers, and behavioral health professionals serving high-stress populations
👥 Agency leaders, peer supporters, and wellness coordinators

Whether you're looking for practical ideas to strengthen your wellness program, improve access to behavioral health resources, or connect with others doing this work, I think you'll find tremendous value in this event.

📅 September 29, 2026
🕣 8:30 a.m.–3:30 p.m.
📍 Jorns Hall, Oklahoma State University – Stillwater, OK
🎓 Behavioral Health CEUs available
💲 Free Registration
🔗 Register: okla.st/R2P2026

I hope to see many of my colleagues, fellow researchers, clinicians, and first responder partners there as we continue working toward healthier, more resilient public safety communities.

Firefighter Su***de and the Culture of Silence

Firefighters are trained to run toward danger, remain calm under pressure, and protect others during their worst moments.

But who supports the firefighter when they are struggling?

A landmark paper by Henderson and colleagues examined the unique cultural challenges surrounding firefighter su***de and why many firefighters never seek the help they need. The authors argued that the greatest barriers are often cultural—not clinical.

The article highlights several important realities:

🚒 Mental toughness is a core part of the fire service culture.

🤐 Stigma can discourage firefighters from discussing emotional struggles.

⚠️ Fear of appearing weak or unfit for duty may prevent help-seeking.

📉 Firefighter su***des have historically been underreported, making it difficult to understand the true scope of the problem.

Perhaps the most important takeaway is this:

Culture can either become a barrier to wellness—or one of the strongest protective factors.

Departments that encourage peer support, educate leaders, normalize conversations about mental health, and provide confidential access to care help create an environment where firefighters can seek assistance before reaching a crisis.

Nearly a decade after this article was published, many of its recommendations remain highly relevant.

As someone who studies preventive mental wellness in first responder organizations, I believe lasting change begins with leadership. Policies matter. Training matters. Peer support matters. But culture ultimately determines whether someone feels safe enough to ask for help.

The strongest firefighters aren't those who never struggle.

They're the ones who recognize when they need support—and work in organizations that encourage them to reach for it.

Read more: Henderson, S. N., Van Hasselt, V. B., LeDuc, T. J., & Couwels, J. (2016). Firefighter su***de: Understanding cultural challenges for mental health professionals. Professional Psychology: Research and Practice, 47(3), 224–230. https://doi.org/10.1037/pro0000072

💬 What changes have you seen in the fire service regarding mental health over the past decade?

What if investing in mental health actually saved your organization money?

One of the biggest concerns I hear from first responder leaders is:

"We'd like to improve mental health services, but can we afford it?"

A 2025 study published in JAMA Network Open offers an important perspective.

Researchers examined nearly 14,000 employees and dependents to determine whether expanding access to behavioral health services resulted in a financial return on investment.

The findings were compelling:

💰 For every $100 invested in enhanced behavioral health services, medical claims costs were reduced by approximately $190.

📉 Participants experienced lower overall medical spending, even after accounting for the cost of the behavioral health program.

📈 Savings were greatest among individuals with higher medical risk.

Behavioral health costs increased—as expected, because more people received care—but those costs were more than offset by reductions in physical health care spending.

What does this mean for first responder agencies?

While this study was conducted in a general employer population—not specifically with first responders—it highlights an important principle that is highly relevant to public safety organizations.

Investing in mental health isn't simply an employee benefit.

It can be a strategic organizational investment.

For first responder agencies, potential benefits may include:

🚑 Reduced absenteeism

👥 Improved employee retention

❤️ Earlier access to care

📉 Lower burnout

🏥 Reduced healthcare utilization

🚒 Healthier, more resilient workforces

🚓 Greater operational readiness

As someone whose research focuses on preventive mental wellness and cost-benefit analyses for first responder organizations, I believe studies like this help shift the conversation.

Instead of asking:

❌ "How much will a wellness program cost?"

We should also ask:

✅ "What is it costing us not to invest?"

Healthy organizations don't just support their people—they strengthen their workforce, improve performance, and may reduce long-term costs.

That's a conversation every first responder agency should be having.

💬 If your agency invested more in preventive mental health, where do you think you would see the greatest return: retention, reduced sick leave, morale, recruitment, or overall performance?

Article Citation:
Hawrilenko, M., Russo, J., Rettew, D., Ludman, E., Yeung, A., & Sullivan, M. (2025). Return on investment of enhanced behavioral health services. JAMA Network Open, 8(2), e2457834. https://doi.org/10.1001/jamanetworkopen.2024.57834 (Note: the published article lists a different author group than the citation you provided.)

We've been talking about burnout in EMS for decades.

Burnout is often discussed as though it's a new problem brought on by recent workforce shortages or the COVID-19 pandemic.

The truth is...

Researchers were documenting burnout among paramedics nearly 40 years ago.

In 1988, Grigsby and McKnew published one of the earliest studies examining work-related stress and burnout among paramedics. Their findings demonstrated that the emotional demands of EMS were already taking a significant toll on those answering the call.

While the profession has evolved, many of the challenges identified then remain familiar today.

🚑 Chronic occupational stress

😓 Emotional exhaustion

⚠️ High operational demands

💔 Compassion fatigue

👥 Staffing challenges

⏰ Long hours and irregular schedules

The message is clear:

Burnout isn't a new problem. It's a long-standing occupational hazard.

For decades, EMS professionals have adapted, persevered, and continued to provide exceptional care despite working in environments that often ask them to give more than they have to give.

The encouraging news is that our understanding of burnout has grown considerably since 1988.

Today we know burnout is not simply an individual weakness or a lack of resilience.

Research consistently shows it is influenced by the interaction between job demands and organizational resources, including staffing, leadership, workload, recognition, support, autonomy, and workplace culture.

That means burnout is something organizations can help prevent—not just something individuals are expected to overcome.

As someone whose research focuses on preventive mental wellness for first responders, I think this article serves as an important reminder:

We've known burnout has been a problem for nearly four decades.

The question is no longer whether burnout exists.

The question is what are we willing to do about it?

💬 For those who have been in EMS for many years—what has changed, and what hasn't?

**Article Citation:**
Grigsby, D. W., & McKnew, M. A. (1988). *Work-stress burnout among paramedics.* *Psychological Reports, 63*, 55–64. https://doi.org/10.2466/pr0.1988.63.1.55

What exactly is moral injury—and how do we measure it?

As conversations about first responder and military mental health continue to evolve, **moral injury** has become an increasingly important topic. But before we can understand it, treat it, or study it, we need reliable ways to measure it.

A 2025 systematic review and meta-analysis by Griffin and colleagues examined the outcome measures used to assess moral injury across research and clinical settings.

The review found that while multiple assessment tools exist, they differ in what they measure, how they define moral injury, and the populations for which they were developed. This highlights both the progress made in the field and the ongoing need for consistent, validated measures.

The authors identified several common dimensions of moral injury:

⚖️ Guilt

💔 Shame

😔 Betrayal

🧭 Violations of deeply held moral values

🤝 Loss of trust

❓ Spiritual or existential conflict

Unlike PTSD, which is often rooted in fear after a traumatic event, moral injury centers on violations of one's moral beliefs or values. It may occur after actions taken, actions not taken, or feeling betrayed by leaders or organizations.

The review also emphasized that measuring moral injury accurately is essential for:

✅ Advancing research

✅ Improving clinical care

✅ Evaluating treatment effectiveness

✅ Better understanding first responder and military experiences

As someone whose work increasingly focuses on preventive mental wellness and moral injury among first responders, I find this review especially valuable. It reminds us that before we can effectively address a problem, we must first understand how to identify and measure it.

As research continues to evolve, so will our ability to recognize moral injury earlier, provide more targeted interventions, and build healthier organizations.

💬 Do you think moral injury is receiving enough attention in first responder wellness discussions?

**Article Citation:**
Griffin, B. J., Price, L. R., Jenkins, Z., Litz, B. T., & Maguen, S. (2025). *A systematic review and meta-analysis of moral injury outcome measures.* *Current Treatment Options in Psychiatry, 12*(1), Article 7. https://doi.org/10.1007/s40501-024-00342-9