Interventions to Reduce Behavioral Health Risks for First Responders

Some researchers have recommended preparedness and assessing the suitability of new staff for the first responder role before they begin work, in order to ensure that their personality and mental health status are such that they can handle the stress of work as a first responder.¹ They have also emphasized the importance of being prepared for the potential psychological impact of the job, as well as of mental health trainings and briefings.¹ A number of disaster preparedness and response actions have been suggested by Mitchell (2011), Brooks and colleagues (2015, 2016), and Quevillon and colleagues (2016), as described in the sections that follow.^1,2,3,4

Preparedness

Leaders and managers can take these steps to support the behavioral health of their teams:

• Plan in advance of disaster mobilization, and develop clear written protocols and strategic plans.² This is important for the behavioral health of first responders because the feeling of being well-prepared and the sense of doing a job well serve as protective factors against behavioral health issues and conditions.⁴
• Include all team members in the development of the protocol, and ensure they are all adequately trained.² Teamwork and sense of community serve as major protective factors for disaster workers.⁴ High sense of team accomplishment and assurance of personal and team capabilities were associated with reduced stress levels.¹
• Gather as much information as possible about the disaster to reduce the dangers from disaster exposure.² Perceived dangers to wellbeing and safety were linked to anxiety, depression, and general psychiatric syndromes.¹
• Develop a clearly defined leadership cadre, establish sub-teams, and determine factors that could prevent some team members from participating.² Organizations should put the welfare of their team at the forefront and move toward a more supportive attitude.⁴
• Model the structure of the team on the Incident Command System (ICS)²: Link opens in a new windowhttps://www.nationalservice.gov/sites/default/files/olc/moodle/ds_online_orientation/viewf265.html.
• Ask potential responders before the disaster to be aware of the stress they are dealing with, and to assess whether they have the capacity to deal with the additional stress the disaster situation will involve. Recognize good work during the disaster, empower staff, and assign responsibility to staff members to have a protective effect.⁴

First responders can take these steps to protect their own behavioral health before deployment:

• Be aware of personal vulnerability, signs of burnout and compassion fatigue, or profound psychological pain; these were symptoms observed by therapists working for long periods with people who have been directly traumatized.^4,5
• Make plans prior to the disaster for self-care during the disaster response and plan on taking breaks, sleeping adequately, eating nutritious meals, and exercising during relief work.⁴

Response

During and after the response, leaders and managers can act as follows to support their teams:

• Develop clear lines of communication.²
• Assess the welfare of the team, resolve any conflicts between team members, and rotate assignments.² The role of leadership is crucial in maintaining the mental health of their team.⁴
• Encourage workers to pair up in a "buddy system" to support each other and monitor each other's stress reactions; provide support to them if needed in doing so.⁴
• Provide mental health and resilience training, and promote counseling and debriefing following stressful situations.^1,4
• Provide team group sessions upon the return to home base, as well as staff support services.² No further assignments should be given before the workers have had sufficient time to recover; relief workers need some time to adjust, ease back into personal life, and take some time before returning to work.⁴

Public Health Intervention Models

Behavioral health interventions to increase resilience and reduce the risk of behavioral health problems in first responders have been tested in a number of studies. In an intervention study for public health personnel without mental health training, a training program in psychological first aid (PFA) increased self-efficacy and confidence in personal resiliency.⁵

Special forces police were eager to participate in the resilience-promotion training program in another study, and they believed their stress reaction was reduced by the program, and that the reduction could improve their performance in the line of duty. They also reported that they felt that resilience training should be provided to special force police officers and that they would recommend the program for their peers.⁶ In an Australian study, firefighters received four hours of resilience training; while the intervention was unable to show evidence of reducing PTSD, the follow-up period was limited, which might have influenced the results.⁷

In a literature review study that investigated 25 burnout-intervention studies, about 80 percent of all studies led to positive effects on burnout; and about 82 percent of all person-directed interventions led to a significant reduction in burnout or positive changes in its risk factors, lasting up to six months after the intervention; while a combination of both person- and organization-directed interventions had longer-lasting positive effects of 12 months and over. However, the study found that the positive effects fade with time, and they suggested a refresher course to enhance the effect of the intervention.⁸

In a study to evaluate a peer-support training program in six public health agencies, the participants demonstrated increased knowledge concerning their ability to identify stress injuries, initiate and maintain conversations, motivate peers to follow through with help-seeking behavior, and provide acute stress management.⁹ Peer-support programs have emerged as the standard practice for supporting staff in many organizations in which employees are at a high risk of experiencing potentially traumatic events. The rationale behind them often includes the goals of meeting the legal and moral duty to care for employees as well as addressing the multiple barriers to standard care, including stigma, lack of time, poor access to providers, lack of trust, and fear of job repercussions.¹⁰ These programs amount to a cultural shift in these professions, in which people typically have not talked much about their feelings regarding their work, particularly their distress.

References

1. Brooks, S.K., Dunn, R., Amlot, R., Greenberg, N., & Rubin, G.J. (2016). Social and occupational factors associated with psychological distress and disorder among disaster responders: A systematic review. BioMed Central (BMC) Psychology, 4, 18. doi: 10.1186/s40359-016-0120-9
2. Mitchell, J.T. (2011). Collateral damage in disaster workers. International Journal of Emergency Mental Health and Human Resilience, 13(2), 121–125.
3. Brooks, S.K., Dunn, R., Sage, C.A., Amlot, R., Greenberg, N., & Rubin, G.J. (2015). Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster. Journal of Mental Health, 24(6), 385–413. doi: 10.3109/09638237.2015.1057334
4. Quevillon, R.P., Gray, B.L., Erickson, S.E., Gonzalez, E.D., & Jacobs, G.A. (2016). Helping the helpers: Assisting staff and volunteer workers before, during, and after disaster relief operations. Journal of Clinical Psychology, 72(12), 1348–1363. doi: 10.1002/jclp.22336
5. Everly, G.S., McCabe, L., Semon, N.L., Thompson, C.B., & Links, J.M. (2014, September/October). The development of a model of Psychological First Aid for non–mental health trained public health personnel: The Johns Hopkins RAPID-PFA. Journal of Public Health Management and Practice, 20, S24–S29. doi: 10.1097/PHH.0000000000000065
6. Andersen, J.P., Papazoglou, K., Koskelainen, M., Nyman, M., Gustafsberg, H., & Arnetz, B.B. (2015). Applying resilience promotion training among special forces police officers. SAGE Open, 5(2). doi: 10.1177/2158244015590446
7. Skeffington, P.M., Rees, C.S., Mazzucchelli, T.G., & Kane, R.T. (2016). The primary prevention of PTSD in firefighters: Preliminary results of an RCT with 12-month follow-up. PLoS One, 11(7), e0155873. doi: 10.1371/journal.pone.0155873
8. Awa, W.L., Plaumann, L., & Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counseling, 78(2), 184–190.
9. Marks, M.R., Bowers, C., DePesa, N.S., Trachik, B., Deavers, F.E., & James, N.T. (2017). REACT: A paraprofessional training program for first responders—A pilot study. Bulletin of the Menninger Clinic, 81(2), 150–166. doi: 10.1521/bumc.2017.81.2.150
10. Creamer, M.C., Varker, T., Bisson, J., Darte, K., Greenberg, N., Lau, W., Moreton, G., et al. (2012). Guidelines for peer support in high-risk organizations: An international consensus study using the Delphi method. Journal of Traumatic Stress, 25(2), 134–141. doi: 10.1002/jts.21685