Mental Health
RAPID MENTAL HEALTH ASSESSMENT DEPARTMENT SUCCESS STORIES REVIEW OF STATE MENTAL HEALTH WORKERS' COMP. LAW
From 1980 to 2016, the number of calls in the US for fire declined 55%, while the number of calls for EMS increased 320%. This increase represents a continuing trend. On average, 64% of fire department 9-1-1 calls were for medical emergencies. For example, the Philadelphia Fire Department (PFD) responds to 700 to 1,000 EMS calls per day (75% of their total call volume) with only 200 paramedics, half of whom are in service at any given time. Fire departments can run out of ambulances on any given day under normal conditions, and the FIRST Center's previous research showed that fire-based EMS responders were already concerned about impacts on their mental health. Events like the coronavirus pandemic highlighted a system under incredible stress.
COVID-19 RAPID Mental Health Assessment
Through the COVID-19 RAPID Mental Health Assessment (RAPID), we assessed firefighter mental health throughout the pandemic across several indicators, including burnout, job satisfaction, work engagement, and PTSD. This enabled tracking of their ability to respond to emergencies and the capacity for their organizations to maintain optimal responsiveness in this unprecedented environment.
In developing RAPID, the FIRST Center took two research activities already in the field and quickly expanded them to measure the mental health impact of the coronavirus outbreak on fire-based EMS responders. The first program is the Fire service Organizational Culture of Safety (FOCUS) survey - a previously validated tool that measures organizational safety climate. The second program is the Stress and Violence to fire-based EMS Responders (SAVER) study that developed a Systems-Level Checklist to reduce stress and workplace violence.
Analysis of RAPID data has revealed that departments in the FOCUS arm of the study experienced a shift in work that occurred during the beginning of the pandemic: firefighters were doing more EMS work. This change likely contributed to an increase in emotional exhaustion and the desire to leave the profession altogether.
We also conducted interviews and focus groups with fire service members of varying rank from 15 of these fire and rescue service departments in September and October of 2020. These findings let first responders tell their stories of how the pandemic affected their work and their lives. This underscores the impact that having access to key resources has on the safety culture within fire departments and on the mental well-being of the individual responder, both during periods of normalcy and of crisis.
Workers' Compensation Law
FIRST Center research published in 2024 reviewed state workers' compensation law and evaluated how these laws support first responders suffering from psychological conditions that may arise due to the stressful and traumatic nature of their work. Most states categorize mental health as 1) physical-to-mental injury, or mental health issues that arise from experiencing a physical injury; 2) mental-to-mental injury, or physical harm resulting from a mental health crisis; or 3) mental-to-mental injury, or mental health issues stemming from previous unresolved psychological concerns. All 50 states support physical-to-mental claims, 44 support mental-to-physical claims, and 40 support mental-to-mental claims.
When it comes to presumption of causation law, however, the number of states that have presumptive legislation for cardiovascular disease, respiratory disease, infectious disease, and others far outweights the number of states that have presumptive legislation for mental health. As an example, 23 states were able to pass presumption laws for COVID-19 during the pandemic, while only 9 states have presumption laws for mental health conditions.
In addition to these gaps, first responders face challenges with the workers' compensation claims process, like latency periods, time limits, and pre-existing health conditions. The burden of proof that the injury stems from the workplace lies with the first responder, who may struggle with this on top of their physical or mental health concerns.
To bridge gaps in policy, states could apply the same "sunset" clauses, or termination dates, to mental injury presumption as they did for COVID-19 presumption.
While presumptive laws are neither perfect nor uniform, they are an important tool in caring for the unique needs of first responders.
Mental Health Resource Guide
In doing this work, we identified that individual first responders may need behavioral health resources, but may not know where to turn to. In response, we created the Mental Health Resource Guide—a comprehensive document that suggests multiple avenues through which first responders can access the resources they need.
The Guide has three categories of resources.
- Department and Leadership Resources: Programs, trainings, and policies that can be implemented at the department-level.
- Member Resources: Hotlines, text lines, confidential chats, and programs that can be utilized by the individual first responder.
- Research Opportunities: Research organizations working with the fire and rescue service on mental health.
For each individual resource, the Guide provides more detail on what it is, any costs and fees associated with it, and who in the department can participate.
This document is provided to all departments who participate in the FOCUS survey, as FOCUS 3.0 asks questions related to department-level anxiety, depression, and suicidal ideation. It is also linked here for any and all departments to access for free. DOWNLOAD THE MENTAL HEALTH RESOURCE GUIDE
Mental Health Research Publications
Policy: r2p
COVID-19 RAPID Mental Health Assessment