First responders (FRs), a broadly inclusive group of “medical and military personnel, firefighters, police officers, paramedics, rescue disaster volunteers, and others,” are repeatedly exposed to trauma and other distressing events (Garner, Baker, & Hagalgans, 2018). These distressing events make them susceptive to mental health issues, such as “acute stress disorder (ASD), post-traumatic stress disorder (PTSD), and depression” (Lanza, Roysircar, & Rodgers, 2018). This research proposal will delve into proposing treatment options and engagement strategies that can help address the mental health of FRs.
Recently, the discussion around mental health issues among first responders (FRs) has increased. There has been a significant increase in the number of mental health claims registered by FRs. There has been a significant increase in media stories profiling FRs who say their mental health issues spring from trauma and stress they experience in the line of their work. FRs constantly experience distressing situations when responding to disasters (Kehl, Knuth, Holubová, Hulse, & Schmidt, 2014) . In addition, FRs repeatedly encounter workplace stressors on the job. Some of the workplace stressors FRs face on the job include heavy workloads, discrimination, and bullying (Kim, Dager, Jeong, Ma, Cho, Lee, Kim, Yoon, & Lyoo, 2018).
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These workplace stressors together with the distressing situations they face when responding to disasters can have an immediate detrimental impact on some FRs; for others, the deleterious effects build up over a significant period of time, which can be in weeks, months, or even years (BC First Responders’ Mental Health, 2019). Some FRs usually experience mental health issues either temporarily or on an ongoing basis. A typical example of the mental health symptoms faced by FRs include ASD), PTSD, and depression (Garner et al., 2018).
The Mental Health of FRs
Garner et al. (2016) carried out a study to determine the traumas experienced by FRs. According to the authors, FRs, who also happen to be the survivors of natural and human-caused disasters, are not given much consideration as a survivor. The author acknowledges that, just like traditional survivors, FRs also deeply affected by trauma. According to Garner et al. (2016), FRs suffer particularly from ASD, PTSD, and depression during and after responding to critical incidents, like natural disasters, fires, and accidents. Garner and his colleague employ a case study methodology in their study. From their case study, the authors found that there is a link between FRs and mental health issues.
Barriers to Promoting Health among FRs
Royle, Keenan, & Farrel (2009) researched to investigate issues of stigma among FRs. From the study, the authors found that there exist some elements of workplace culture that can have a detrimental impact on the mental health of FRs. One such element is stigma, which is still prevalent among FRs. According to Royle et al., (200), one of the main factors that stop FRs from pursuing mental health treatment is stigma. Many people finding it very difficult to talk about suicide or other mental health condition with an individual who seems to be struggling with it. This is because they fear to say something that will bring them harm or saying the wrong thing.
In another study, Jones, Agud, & McSweeney carried out research to determine the factors that influence the way FRs perceive mental health issues and their engagement in mental health services. The authors found workplace confidentiality to be one of the barriers to accessing services. Workers sometimes fear to access services, such as treatment or support services, because they fear it may influence how other workers or the management sees or treats them. Despite believing that mental health and wellness is important, FRs may be inclined to seek help due to these concerns. These concerns are significant barriers to promoting mental health. The authors state that there is a need to tackle these barriers to address the mental health issues faced by FRs. According to the authors, one way to address these barriers is to have a cultural shift in FR organizations. This can be achieved by ensuring all workers in the workplace are committed to working together to improve mental health.
In another study, Johnson et al. (2019) carried out a systematic review to determine the prevalence of mental health problems among FRs and to explore treatment engagement strategies in FRs. From their systematic study, the authors found that FRs are rarely inclined to seek treatment due to stigma, structural barriers, and anticipating negative outcomes from treatment. Failure to seek treatments makes FRs susceptible to developing mental problems with time. The authors outline some treatment engagement strategies. According to the authors, some of the strategies that can be used to addressed treatment barriers include “peer support, informal support, telehealth approaches (e.g., digital storytelling), work-recovery strategies, mindfulness, and critical incident stress management.”
Engagement Strategies Used to address Mental Health of FRs
Regeher (2005) carried out a study to explore the impact of trauma exposure on spouses of paramedics. From the study, the author found that family, friends, and the workplace play a significant role when it comes to providing support to FRs having mental health issues. According to Regeher (2005), with the right support, FRs experiencing symptoms of mental health can still have positive outcomes. In addition, the workplace environment and its culture also play a vital when it comes to providing to FRs having mental health issues. These two factors dictate how workers respond to challenges. Regeher (2005) states that workplace environments characterized by a strong sense of community and camaraderie often make FRs and other employees working in the organization have a protective and positive on individuals’ wellbeing.
FRs are repeatedly exposed to distressing situations. These events make them susceptible to ASD, PTSD, and depression. Different studies have researched the link between FRs and mental health issues as well as determine the barriers and engagement strategies to mental health promotion of FRs. Some of the barriers highlighted by the studies reviewed include stigma, lack of workplace confidentiality, structural barriers, and anticipating negative outcomes from treatment. Other studies have proposed engagement strategies to address the mental health problems that FRs face. Some of the strategies highlighted by the studies reviewed include the right support from family, friends, and in the workplace. However, a research gap exists in the literature. The existing literature does not give enough information on how the availability of treatment, peer support, and positive culture in an organization can make FRs inclined to seek treatment. This research aims to examine if FRs are more likely to seek treatment when their department has treatment/peer-support/access positive culture.
Research Hypothesis
The hypothesis for this proposed study is that first responders are more likely to seek treatment when their department has treatment positive culture available.
Research Methodology
Participants
The study population will consist of currently employed first responders in Texas. For this proposed study, participants will be recruited through email invitations, using convenience and snowball sampling methods. A total of 700 first responders are expected to participate in this proposed study. The age of the participants will range from 18 years to 66 years. The participants will be drawn from the following occupations in Texas: different categories of emergency medical service personnel (nurses, ambulance personnel and medical technicians), firefighters, police officers, paramedics, rescue disaster volunteers. Length of services will range from 0 to 36 years. The participants will be identified through collaboration with senior management as well as union representatives from FR agencies. This proposed research study will work in conjunction with First Responders Foundations in Texas. FRFs are foundations in the U.S. that are solely dedicated to the health and wellbeing of FRs.
Procedure
This proposed study will employ a survey methodology using a questionnaire. A questionnaire is a research instrument that is composed of a series of questions that are devised primarily to collect information from respondents. The instrument that will be employed in the study will consist of an online and offline questionnaire. To gather the information from respondents, questionnaires will be sent to FRs that will express interest in participating in the study. An online questionnaire will be sent to participants that are not easily accessible. The questionnaires will be sent via email or other social media platforms. The participants that are easily accessible will be provided with printed questionnaires. The printed or written questionnaires will be administered to the participants that are easily accessible on a drop and pick basis. To facilitate this process, questionnaires will be sent to all department that works with first responders. The questionnaires will then be distributed to participants by a contact person with each department. This will help maximize the response rate. The survey will be conducted between April 27, 2020, and April 30, 2020 .
Ethical Consideration
The study will ensure strict anonymity as well as secure data management. The protection of all participants will be ensured through approval by the Le Tourneau University Institutional Review Board (IRB) . The study will proceed only after the institution approves the study protocol and grants a waiver of informed consent. Included in the questionnaires will be a general introduction to the purpose of the study and a consent form. The participants will be asked to sign the consent form as a precondition to proceeding with the completion of the questionnaire. The participants will be asked to take part in the study on a voluntary basis, and all data will be collected anonymously. Contact information will be provided to the participants that will request a follow-up. After completing the questionnaires, the participants will be asked to email back the forms.
Instrument
The questionnaire to be used in the study will include the following areas:
Demographics : Some of the demographic questions that will be included in the questionnaire include gender, age, and length of service.
Work-related health outcomes: The study will also assess work-related health outcomes among the participants of the study using the ProQOL R-IV (Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales –Revision IV). The participants will be asked to specify how often, in their line of work, they experience a series of emotional states. The participants will be asked to give their responses on a five-point Likert scale, ranging from “never” (value 1) to “very often” (value 5). The ProQOL –IV will be subjected to Factor Analysis procedures. Based on the analysis, culturally inappropriate items or items with unsatisfactory psychometric properties will be discarded.
Collective Efficacy and Self Efficacy: Collective Efficacy and Self Efficacy will be measured by the “Perceived Collective Efficacy for members of volunteering association.” With regard to “collective efficacy,” the degree to which members perceive their departments is capable of facing challenges from their activity will be assessed. With regard to “Self Efficacy,” the degree to which members of a given department feel capable of facing the challenges arising during their typical everyday activity will be measured. The responses will be measured on a five-point Likert scale, ranging from “completely agree” (value 5) to (completely disagree” (value 1).
Organization Culture: This survey component will focus on exposure to stress, wellbeing, and organizational support. The participants will be asked if their department or organization has treatment positive culture available. The participants will be asked to provide their responses on a two-point scale, “Yes” or “No.” If the answer is “Yes” the participant will be asked to provide a response on how likely they are to seek treatment in their department. The participants will be asked to give their responses on a five-point Likert scale, ranging from “very unlikely” (value 1) to “very likely” (value 5).
Data Analysis
All participant data from the questionnaires will be analysed using standard statistical techniques. Microsoft Excel and other tools will be used to facilitate the analysis. The hypothesis that was constructed will then be tested.
References
BC First Responders’ Mental Health. (2019). Supporting mental health in first responders: Recommended practices. [Online]. Retrieved April 17, 2020, from https://bcfirstrespondersmentalhealth.com/wp-content/uploads/2017/05/Recommended-Practices-for-Supporting-Mental-Health-in-First-Responders-191029.pdf
Garner, N., Baker, J., & Hagelgans, D. (2016). The private traumas of first responders. The Journal of Individual Psychology , 72 (3), 168-185.
Jones, S., Agud, K., & McSweeney, J. (2019). Barriers and Facilitators to Seeking Mental Health Care among First Responders: “Removing the Darkness.” Journal of the American Psychiatric Nurses Association , 1078390319871997.
Johnson, C. C., Vega, L., Kohalmi, A. L., Roth, J. C., Howell, B. R., & Van Hasselt, V. B. (2019). Enhancing mental health treatment for the firefighter population: Understanding fire culture, treatment barriers, practice implications, and research directions. Professional Psychology: Research and Practice .
Kehl, D., Knuth, D., Holubová, M., Hulse, L., & Schmidt, S. (2014). Relationships between firefighters’ postevent distress and growth at different times after distressing incidents. Traumatology , 20 (4), 253
Kim, J. E., Dager, S. R., Jeong, H. S., Ma, J., Park, S., Kim, J., ... & Cho, H. B. (2018). Firefighters, posttraumatic stress disorder, and barriers to treatment: Results from a nationwide total population survey. PloS one , 13 (1).
Lanza, A., Roysircar, G., & Rodgers, S. (2018). First responder mental healthcare: Evidence-based prevention, postvention, and treatment. Professional Psychology: Research and Practice , 49 (3), 193-204. http://dx.doi.org/10.1037/pro0000192 .
Pittaro, M. (2019). Mental health care for first responders. [Online]. Retrieved April 12, 2020, from https://www.psychologytoday.com/us/blog/the-crime-and-justice-doctor/201907/mental-health-care-first-responders
Regehr, C. (2005). Bringing the trauma home: Spouses of paramedics. Journal of Loss and Trauma , 10 (2), 97-114.
Royle, L., Keenan, P., & Farrell, D. (2009). Issues of stigma for first responders accessing support for post traumatic stress. International journal of emergency mental health .
