Problem:
Introduction:
This literature review will examine the growing prevalence of mental health issues among public safety personnel, highlighting the impact of long-term stressors, workplace violence, and the potential benefits of interventions such as physical activity and therapy dogs. Public safety personnel (PSPs) regularly experience long-term stressors that contribute to a higher prevalence of negative health effects compare to other job (Kaplan et al., 2017). The increase in mental health concerns among first responders, is evidenced by the rising rates of depression, burnout, and suicides (Dvoskina & Cole, 2020). Furthermore, an emerging body of research highlights the role of childhood trauma in mental health (Behnke et al., 2020) address a critical role previously overlooked in the field. First responders,such as firefighters and paramedics, have a greater risk of developing psychopathology due to their routine exposure to workplace violence (Setlack et al., 2021), which has been shown to contribute to the prevalence of anxiety-related chronic pain (Carleton et al., 2018). Research shows that approximately 30% of first responders develop behavioral health conditions, including depression and PTSD, compared to 20% in the general population. Research indicates that physical activity plays a crucial role in reducing stress and creating healthy workplaces (Joyce et al., 2019). Finally, research is being conducted on the efficacy of using therapy dogs for first responders and 911 call-takers (Dvoskina & Cole, 2020). This literature review will analyze the current studies regarding first responder mental health and the research concerning individuals working on the front lines of public health and safety.
Discussion:
The article talked resilience, resilience can be considered as "a dynamic process reflecting a person's ability to adapt, manage, and recover effectively from stressful experiences and adverse circumstances"(Joyce et al., 2019). The ability to "bounce back" is an essential skill for all front-line personnel. One group of (PSP) who require a high degree of resilience are 911 dispatch operators (Dvoskina & Cole, 2020). These call takers are at an exceptionally high risk of developing compassion fatigue and face unique challenges to stress management and trauma decontamination (Dvoskina & Cole, 2020). Unlike paramedics and firefighters, who are physically active during a shift, 911 operators sit in one place for hours in high-stress environments due to the nature of their jobs. Study participants reported that downtime was spent either sleeping or sitting at a desk completing paperwork. Studies indicate that prolonged sedentary periods are linked to obesity, hypercholesterolemia, and hypertension, which increase the likelihood of psychological stress (Dvoskina & Cole, 2020).
Evidence suggests that prolonged sitting creates an additional obstacle to trauma mitigation (Dvoskina & Cole, 2020) and that 911 operators would benefit from a different approach to the delivery of therapeutic services (Dvoskina & Cole, 2020). Research supports the conclusion that "movement is a key factor in trauma resolution and that sedentary states can contribute to an increase in trauma symptoms." It is understandable then that the inability to move in response to sympathetic nervous system activation may result in fatigue and depression. In addressing trauma as a functional whole with both linguistic and nonverbal integration, one may be better able to adapt to the chaotic feelings triggered by the traumatic experience itself (Dvoskina & Cole, 2020). In other words, physical activity is necessary for the body to process stress hormones produced during "fight or flight" and signal to the brain that the immediate threat has been mitigated. In fact, research has shown that canine therapy is especially effective in resetting the sympathetic nervous system (Dvoskina & Cole, 2020).
A retrospective study of emergency medical personnel published in 2019 investigated whether PSP with childhood maltreatment were at increased risk of mental and physical stress symptoms after exposure to occupational trauma (Behnke et al., 2020). Data from 130 German EMS personnel was collected as part of a cross-section survey distributed to the regional Red Cross. Participants self-reported with an anonymous questionnaire that asked about childhood abuse/mistreatment, exposure to occupational trauma, as well as post-traumatic and depressive feelings that included somatic symptoms (Behnke et al., 2020). The study results provided initial evidence that childhood trauma could increase vulnerability to high-stress levels while on duty.
A recent study at the University of Manitoba showed that in 2019, over 80% of paramedics and firefighters experienced violence directed at them by the public. However, its impact on mental health is poorly understood (Setlack et al., 2021). Recent events in the media demonstrate that workplace violence is increasing. However, there continues to be a severe lack of comprehensive research into how these events affect first responders over time. A systematic review found that psychological injuries, such as anxiety and mental exhaustion, were linked to on-scene violence; however, the literature has not outlined the extent of the association between them(Setlack et al., 2021). Social support can be a critical factor in developing resilience, but outside of studies focused on police, information on how to provide that support to EMS personnel is nonexistent. This may be due to an unspoken allegiance to an ethos of "silent trauma".
Missing From the Knowledge Base
The current knowledge base around public safety personnel (PSP) mental health is significantly insufficient in the United States, where there is a lack of comprehensive information on the prevalence of mental health issues linked to occupational stress, burnout, and trauma exposure among PSPs. The existing research primarily focuses on countries like Canada, Germany, and Australia, leaving a gap in understanding the unique challenges faced by U.S. responders, who bear the brunt of significant costs related to mental health outcomes, including decreased staffing, on-the-job injuries, and disability claims due to anxiety and chronic pain (Carleton et al., 2018).
Moreover, critical pieces, such as race and gender identity, have not been adequately addressed in the research, potentially obscuring the differential impacts of trauma and workplace violence on diverse populations within the PSP community. There is an urgent need for both qualitative and quantitative research to explore how these demographic factors interact with mental health outcomes that improves our understanding of resilience, and informs the development of wellness training programs. By investigating these areas, public health systems can better support the mental and emotional well-being of those tasked with ensuring community safety, ultimately leading to healthier work environments and improved public health outcomes.
Code of Ethics:
In analyzing the literature on PSP mental health through the lens of the NASW Code of Ethics, there are two core values stand out to me. Social justice and dignity and worth of the person. This literature review reveals a concerning lack of attention to the mental health struggles of PSPs, particularly in the United States, showing an inequitable distribution of resources and recognition needed for this vulnerable population. This aligns with the value of social justice, as the prevailing issues of high rates of mental distress and inadequate support systems show the systemic inequalities in working conditions and well-being resources for first responders.
Moreover, the discussion of childhood trauma's impact on PCP's resilience and susceptibility to stressors speaks to the need for recognizing the dignity and worth of each individual. As social work researchers engage in further research, they have to prioritize the lived experiences of PSPs, consider the comprehensive approaches to their mental health and resilience, and ensure that the voices of those affected are included in the discourse.
Conclusion:
In conclusion, the mental health challenges faced by (PSPs) emphasize a critical need for awareness and research in this area, particularly in the United States. As this literature review highlights, factors like childhood trauma, occupational stress, and the unique work environments. The lack of comprehensive understanding and support for PSPs not only reflects systemic inequalities but also calls for urgent attention to diversify research efforts and address demographic variables that influence mental health outcomes. By emphasizing social justice and the dignity of the individual, partners can develop more effective interventions and support systems that promote the mental and emotional health of those who serve on the front lines of public safety.
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